Dietetic Practice Research Articles

Medical Nutrition Therapy in Gestational Diabetes Mellitus

Aim: The aim of this study was to elicit information on the perception of dietitians about gestational diabetes mellitus (GDM) and their dietetic practices. Materials and Methods: A survey was conducted among dietitians working in hospitals, maternity centers, and other clinics using the purposive sampling criterion. A validated questionnaire was used to obtain details about the perception of GDM, guidelines used, dietetic screening, assessment, interventions and follow-up. Descriptive statistics were reported as frequency of total number of responses for each question. Fisher's exact test on perception of GDM, operating guidelines and topics discussed in diet consultations with respect to the years of clinical experience, age group and educational qualification of the participants were performed. Results: Perception of dietitians on family history of type2 DM as an associated risk factor of GDM had significant association with their clinical experience. Majorly discussed topic in diet consultation was carbohydrate distribution followed by protein requirement, fiber and small frequent meal pattern. On the basis of clinical experience of dietitians, difference was observed in discussed topics such as hypoglycemia, food groups, post-natal diet, and breast feeding. A major inconsistency observed was the nonavailability or lack in the use of pregnancy specific screening tool. Conclusion: Specific screening tools for pregnancy should be brought into practice. There is also the need for sustainable protocols in hospitals for uniformity in management of GDM.

Academy of Nutrition and Dietetics: Revised 2022 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Adult Weight Management

A person’s weight is an anthropometric measure factored into assessing health risk, not a measure of worth, ability, or overall health. Adult weight management is a spectrum of lifelong care services available for persons whose goals can be achieved through evidence-based, weight-related interventions and intersects most practice areas of nutrition. An adult weight management registered dietitian nutritionist (RDN) is responsible for providing a psychologically safe, accessible, and respectful setting and empowering care to those seeking nutrition services. This requires the RDN to act as an advocate by proactively seeking to identify personal and external weight biases, understanding the influence of those predispositions, and acknowledging how weight-related prejudices are intricately connected with systems that influence nutrition both inside and outside of health care. Increases in average weight influence potentially counterproductive discussions about judgment, an individual’s body, and relationship with health. RDNs are equipped to provide dynamic care and be on the forefront of implementing weight-inclusive built environments, policies, and person-centered communications to minimize harm and maximize benefit for the individual and society. The authors, Weight Management Dietetic Practice Group, and the Academy of Nutrition and Dietetics Quality Management Committee revised the Standards of Practice and Standards of Professional Performance for RDNs in Adult Weight Management to update established criteria of competent practice, further define core values, and set direction for future areas of opportunity. The Adult Weight Management Standards of Practice and Standards of Professional Performance are complementary tools intended for RDNs to benchmark and identify progressive routes and goals for professional advancement.

A novel perspective of Australian primary care dietetics: Insights from an exploratory study using complex adaptive systems theory

AimsEffective quality improvement strategies are essential to enhancing outcomes of dietetic care. Interventions informed by complex adaptive systems theory have demonstrated effectiveness in other healthcare settings. This study aimed to explore primary care dietetics practice using complex adaptive systems theory and to identify factors that individuals across the healthcare system can examine and address to improve the quality of dietetic care.MethodsQualitative analysis of semi‐structured interviews of healthcare consumers and professionals involved in the provision of dietetic care. Data collection and analysis was guided by a complexity‐informed conceptual framework. The Framework Method was used to code transcripts and identify themes describing primary care dietetics.ResultsTwenty‐three consumers and 26 primary care professionals participated. Participants described dietetic care as being delivered by individuals organised into formal and informal systems that were influenced by the wider environment, including legal, economic, and socio‐cultural systems. Dietitians described interactions with consumers as a learning opportunity and sought education, mentoring, or supervision to address knowledge and skill gaps. Relationships underpinned transfer of information between individuals.ConclusionComplex adaptive systems theory proved to be a useful conceptual framework for primary care dietetics. Factors identified at the macro (e.g., funding), meso (e.g., professional networks), and micro (e.g., consumer education) levels should be examined and addressed to improve the quality of dietetic care.

Assessing Institutional Support From Dietetics Associations Toward Integration of Sustainable Food Concepts in Dietetics Practice

The degrees to which diets are consistent with food system sustainability, are the result of influences across scales of social interaction. This study considers the importance and limitations of institutional influence over integration of sustainable food systems ideas and concepts in dietetics practice. Working with the International Confederation of Dietetics Associations (ICDA) and their Member Country Associations our objectives are to (a) understand ways by which ICDA could contribute to global sustainable food systems, (b) develop a method for assessing ICDA's contribution to sustainable food systems and (c) test initial data collection options for this assessment. Assessment of institutional support for sustainable food system integration to practice was conducted by examining usage data (from Google Analytics) of the ICDA sponsored online sustainable food system Toolkit, and website content analysis. Study results establish baseline data and indicate initially modest support for backing integration of sustainable food system concepts within the dietetics profession.

Skills, Satisfaction, and Future Recommendations for Salary and Benefit Negotiation Success Among Nutrition and Dietetics Professionals in the United States

ObjectivesThis study aimed to analyze the thoughts, feelings, and experiences of nutrition and dietetics professionals in the United States related to salary and benefit (S&B) negotiation. There is a lack of tools and training to assist in S&B negotiations within the nutrition profession. This study is the first to analyze these variables to formulate solutions for working professionals. MethodsNutrition and dietetics professionals (N = 1239), 22 to 90 years of age, completed a 32-question, web-based survey in the late spring of 2021. Study information was disseminated via professional organization mailing lists, Dietetic Practice Groups, State dietetics groups, and social media pages/groups. Survey items addressed experience with, confidence in, interest in advancing skills to negotiate S&B, and past successes with negotiation. ResultsParticipants were mostly white (90.2%), female (94.5%), Registered Dietitian (RD) (96.8%). Clinical nutrition practitioners had significantly lower salary satisfaction, experience, confidence, and negotiation success (p < 0.001) than all other practice areas but had a significantly higher interest in advancing S&B negotiation skills (p = .017). Those making $100,000 or more per year had the most negotiation experience, found the possession of negotiation skills to be the most valuable (p = 0.049), and had significantly more negotiation success (p < 0.001) than those making less than $74,000 per year. ConclusionsThis study adds new and vital negotiations, with tailored training for success in different practice areas of nutrition and dietetics. information to the body of literature on S&B negotiation in the nutrition and dietetics profession. Early education, exposure, and empowerment are key factors in improving the negotiation experience. Future efforts by nutrition-focused professional organizations should aim to create continuing education opportunities to advance skills and confidence in S&B. Funding SourcesNone.

Use of SmartIRB Does Not Reduce IRB Review Time in a Non-federally Funded, Multi-Site Malnutrition Study

ObjectivesWe evaluated the efficiency of using the SmartIRB platform compared to other site IRB approval mechanisms in the multi-site Academy and ASPEN Indicators to Diagnose Malnutrition (AAIM) Validation and Staffing Optimization Study.MethodsProcess data on the time to execute reliance agreements were collected when on-boarding sites for the AAIM Study (ClinicalTrials.gov: NCT03928548). Acute care hospital site recruitment occurred from September 2018 to December 2021. Research sites joined the study by either executing a reliance agreement with the single IRB of Record (sIRB) or by obtaining full local IRB approval from their institution. Reliance agreements were established through the SmartIRB model, an IRB authorization agreement (IAA), or a Letter of Support. Data are presented descriptively as number of observations and respective percentages or means ± standard deviations (SD).ResultsAs of September 2021, 82 sites received IRB approval for the AAIM Study through the submission of 69 individual IRB applications. Sixty sites were affiliated with SmartIRB. Forty-one applications established a reliance agreement with the sIRB: 31 of 69 used the SmartIRB model (44.9%), 7 used an IAA (10.1%), and 3 used a Letter of Support (4.3%). Twenty-eight applications were submitted for full local review (40.6%). For all 69 submissions, the average time from the initial contact to site activation by the sIRB was 496.9 ± 213.6 (SD) days. SmartIRB had the longest review period of 546.1 ± 220 days; followed by full local review (492.6 ± 213.9 days), then IAA (377.4 ± 143.7 days), and Letter of Support (306.3 ± 58.2 days).ConclusionsThe use of an sIRB and the SmartIRB platform did not to reduce the time required for IRB review of this non-federally funded study. These findings should be interpreted acknowledging several disruptions to IRB activity during the study recruitment timeframe (e.g., accelerated implementation of single IRB review starting in 2018, Common Rule changes in 2019, and the COVID-19 pandemic starting in 2020).Funding SourcesThe AAIM Study was funded by the Academy of Nutrition and Dietetics Foundation, the Commission on Dietetic Registration, the Pediatric Nutrition Practice Group, the Clinical Nutrition Management Dietetic Practice Group, and the Renal Dietitians Practice Group.

Exclusive enteral nutrition practices in the management of Crohn's disease: A cross sectional survey of specialist paediatric dietitians.

Exclusive enteral nutrition (EEN) is the first line management to induce remission of active Crohn's disease (CD). EEN is well established but there continues to be significant variation in practice especially in relation to what first line formula is used, length of time on EEN, and food reintroduction. The survey aimed to establish dietetic practices in implementing EEN in the management of active CD across specialist paediatric inflammatory bowel disease (IBD) centres. An online, cross-sectional survey was developed, piloted, and distributed to dietitians working at tertiary paediatric IBD centres. Centres were identified through a member of the British Society of Paediatric Gastroenterology, Hepatology, and Nutrition (BSPGHAN) working group. All 20 specialist IBD centres within the United Kingdom were approached and invited to complete the survey. Eighty-five percent (17/20) of the specialist IBD centres in the UK responded. 100% of centres used polymeric feeds as their first line and 70% (12/17) of centres recommended EEN for 6 weeks. Dietetic monitoring whilst on EEN over the 6-8 weeks varied significantly, ranging from 30% (5/17) of centres monitored weekly compared with 30% of centres (5/17) only if clinical need indicated. There was a wide range in practices regarding which foods and drinks were permitted whilst on EEN. Forty three percent (7/17) introduced solid foods over five to seven days, 19% (3/17) introduced food over seven to 14 days and 38% (6/17) introduced food over a minimum of 14 days. Eighteen percent (3/17) of centres were offering the Crohn's disease exclusion diet as a treatment for IBD. Despite available evidenced based guidelines there is still considerable variation in the management of EEN to induce remission in active CD especially in relation to frequency of dietetic review and foods permitted during and after EEN. Further research is required to understand the impact this may have on achieving and maintaining remission in CD.

A 3‐D approach to personalised nutrition

A <scp>3‐D</scp> approach to personalised nutrition

Validity and reliability of a questionnaire measuring EBDPs among registered dietitian nutritionist.

There is a lack of a valid and reliable instrument that measures objective and subjective knowledge of evidence-based dietetic practices (EBDP) among registered dietitian nutritionists (RDNs). The present study aimed to develop and assess the validity and reliability of an EBDP Questionnaire (EBDPQ) with objective knowledge items (i.e., quiz items) among RDNs in the USA. Subscales from four existing evidence-based practice (EBP) instruments were combined and modified for dietetics. Content and face validity and internal consistency were used to assess the full survey. Survey responsiveness and test-retest reliability were evaluated within the objective knowledge subscale. Content experts (n = 11) and nutrition professionals (n = 16) completed validation reviews. Doctoral students enrolled in a research course (n = 12) were used to analyse survey responsiveness. Internal and test-retest relability analyses utilised RDN participants (time point 1, n = 482; time point 2, n = 335). Content validation resulted in a 38-item questionnaire. Average percent agreement among face validity reviewers was 95.1%. Only the pre-validation version of the objective knowledge subscale resulted in significantly higher post-course scores (Mdn = 11.50) compared to the pre-course (Mdn = 9.75, p = 0.05). The validated instrument had excellent internal consistency (Cronbach's α = 0.91); however, the objective knowledge subscale was low (Cronbach's α = 0.41). A good degree of reliability was found between the two time points (intraclass correlation coefficient = 0.71). The EBDPQ demonstrated adequate validity and reliability among RDNs. Future research should assess construct validity, with the responsiveness and objective knowledge subscale requiring additional evaluation through an EBDP course.

Medical nutrition therapy for gestational diabetes mellitus in Australia: What has changed in 10 years and how does current practice compare with best practice?

The present study aimed to report Australian dietetic practice regarding management of gestational diabetes mellitus (GDM) and to make comparisons with the findings from a 2009 survey of dietitians and with the Academy of Nutrition and Dietetics Evidence-Based Nutrition Practice Guidelines (NPG). Cross-sectional surveys were conducted in 2019 and 2009 of dietitians providing medical nutrition therapy (MNT) to women with GDM in Australia. The present study compares responses on demographics, dietetic assessment and interventions, and guideline use in 2019 vs. 2009. In total, 149 dietitians (2019) and 220 (2009) met survey inclusion criteria. In both surveys >60% of respondents reported dietary interventions aiming for >45% energy from carbohydrate, 15%-25% energy from protein and 15%-30% energy from fat. Many variations in MNT found in 2009 continued to be evident in 2019, including the percentage of energy from carbohydrate aimed for (30%-65% in 2019 vs. 20%-75% in 2009) and the wide range in the recommended minimum daily carbohydrate intake (40-220 and 60-300 g). Few dietitians reported aiming for the NPG minimum of 175 g of carbohydrate daily in both surveys (32% in 2019 vs. 26% in 2009). There were, however, some significant increases in MNT consistent with NPG recommendations in 2019 vs. 2009, including the minimum frequency of visits provided (49%, n = 61 vs. 33%, n = 69; p < 0.001) and provision of gestational weight gain advice (59%, n = 95 vs. 40%, n = 195; p < 0.05). Although many dietitians continue to provide MNT consistent with existing NPG, there is a need to support greater uptake, especially for recommendations regarding carbohydrate intake.

Clinical Dietetics Practice Audit in India: A Collateral Collaboration of Dietitians from India and the United States

Dietetics is a global profession, yet there are significant differences in dietetics education, training, and scope of practice among countries.1 The International Confederation of Dietetic Associations (ICDA) facilitates international professional definitions to address these differences. A dietitian is defined as a professional who applies the science of food and nutrition to promote health, prevent and treat disease, and to optimize the health of individuals, groups, communities, and populations.

Impact of the COVID-19-induced shift to online dietetics training on PDEP competency acquisition and mental health.

Purpose: A pilot study to investigate the impact of the COVID-19 pandemic and shift to online learning and practicum training on dietetics students' perceptions of Partnership for Dietetic Education and Practice (PDEP) competency acquisition and mental health.Methods: Dietetics students (n = 19) at the University of Guelph (2020-2021) were invited to complete an anonymous online survey to assess self-reported online dietetics practicum training experiences including (i) benefits and challenges, (ii) PDEP competency acquisition, and (iii) impact on mental health.Results: The benefits of online dietetics training included schedule flexibility (42.1%), reduced commute time (31.6%), and acquiring virtual counselling experience (21.1%). Reported challenges were insufficient communication with preceptors (36.8%), increased project workload (57.9%), and technology (15.8%). In online practicum placements, 52.6% of dietetics students reported adequately acquiring all PDEP competencies, with Nutrition Care identified as the most challenging to obtain (63.2%). A negative impact on mental health and increased levels of stress/anxiety were reported in 94.7% of trainees. Notably, 63.2% of students favoured continuation of online dietetics training through a hybrid or entirely online format.Conclusion: Online dietetics training has the potential to complement the traditional in-person model; however, further adaptation is required to optimize PDEP competency acquisition and students' mental health.

Dietetic Students’ Perceptions of Learning Professional Competencies with Four Simulations Throughout a Semester

In nursing and medicine, taking part in simulation activities has been shown to be beneficial for students' learning; however, little has been documented in dietetics. This study aimed to document the perceived effect of 4 simulations on development of professional competencies by dietetic students. A mixed-method convergent approach was used with pre- and post-questionnaires, interviews, and a focus group discussion to look at dietetic students' perceptions of learning as part of a Nutrition Assessment course. Nonparametric tests for questionnaires and theme analysis for transcripts were used to examine data. After analysis, data were compared and merged for interpretation. Results showed that participants perceived a significant increase in comprehension of various competencies with simulations. In interviews and a focus group, a participant subgroup (n=7) perceived an enriched understanding of some dietetic competencies compared with pre-simulations. Simulations seemed to have transformed classroom concepts to a more practical understanding of dietetic practice. More studies are needed to identify if these results could be replicated in different settings. Simulations had a positive effect on students' perception of competencies development and may be an andragogical tool of choice to support preparing future dietitians for entry to practice.

What is the value of supplementary prescribing in the 2020s? A dietitian's perspective

Background Non-medical prescribing is well-established in healthcare. Two models are used in practice: supplementary prescribing and independent prescribing. Supplementary prescribing incorporates higher levels of supervision and governance and is the model permitted for use by dietitians. Aim To explore the value of supplementary prescribing from a dietitian's perspective. Method Non-medical prescribing models will be evaluated to establish the benefits and drawbacks of each and discussed in relation to dietetic practice. Results Both models of prescribing are perceived positively by patients. Training for both models is identical and enables the practitioner to work within their scope of practice. However, the clinical management plan, necessary for supplementary prescribing, is limiting and can prevent practitioners from implementing their role efficiently. Conclusions Supplementary prescribing has allowed dietitians to begin prescribing, but for other professions, this model has been superseded by independent prescribing. Supplementary prescribing may be becoming redundant in the 2020s.

Undertaking a research project improves confidence in research skills among student dietitians

BackgroundResearch is a cornerstone of evidence‐based dietetic practice. Research skills are often taught at university through experiential learning during a final‐year research project. The present study aimed to investigate attitudes towards research and confidence in research skills among student dietitians before and after a research project.MethodsA questionnaire survey of student dietitians’ attitudes to research and confidence in research skills was undertaken before and after completing a research project at two universities in London, UK. Dichotomous data were compared before and after the research project using a McNemar's test. Factors associated with ‘high confidence’ or ‘improved confidence’ in overall research skills at the end of the research project were investigated using multivariable logistic regression.ResultsIn total, 160 student dietitians completed a questionnaire before and after their research project. The majority had positive attitudes to research both before and after their research project. There was an increase in numbers with ‘high confidence’ in overall research skills before (13; 8.1%) and after (79; 49.4%) the research project (p < 0.001), and 113 (70.6%) reported ‘improved confidence’ in overall research skills. The only factor associated with ‘high confidence’ in overall research skills was having ‘high levels of involvement in the overall research process’ (odds ratio = 6.13, 95% confidence interval = 2.03–18.49, p = 0.001).ConclusionsStudent dietitians have positive attitudes towards research and undertaking a research project significantly improves confidence in their research skills. A higher level of involvement in the research project is the single most significant factor associated with high confidence in research skills.

Trends Related to Evidence-Based Dietetic Practice Among Dietitians With Varying Levels of Education and Experience

This qualitative study evaluates registered dietitian nutritionists' (RDNs) use of evidence-based dietetic practices (EBDPs) by education level and years of experience. Interviews were conducted with bachelor's and master's-trained RDNs (n = 9). The following themes regarding EBDP were identified: (1) resources utilized, (2) personal utilization and perceptions, (3) barriers and areas for improvement, and (4) collaboration. It was noted that master's-trained RDNs were more knowledgeable regarding EBDP resources. While it was reported that EBDP had improved with experience, those further from their didactic training had less awareness of EBDP resources. Continuing education should aim to bridge this gap in knowledge among RDNs.

The therapeutic relationship between a client and dietitian: A systematic integrative review of empirical literature.

AimScientific evidence underpins dietetics practice; however, evidence of how the therapeutic relationship influences outcomes is limited. This integrative review aims to provide a comprehensive overview of the topic of the therapeutic relationship between clients and dietitians in the individual counselling context by summarising empirical literature into qualitative themes.MethodsAn electronic literature search of the Cumulative Index of Nursing and Allied Health Literature, PsychInfo, Scopus and Web of Science databases was conducted in October 2018 and repeated in February 2021. Studies were included if they explicitly referred to the therapeutic relationship (or associated terms), were based on study data and available in full text. Extracted data were checked by a second researcher and the methodological quality was evaluated independently by two researchers using the Mixed Methods Appraisal Tool. An iterative process of qualitatively coding, categorising and comparing data to examine recurring themes was applied.ResultsSeventy‐six studies met the inclusion criteria. Five themes were identified which showed the extent and nature of research in this area. Studies revealed the therapeutic relationship: (i) is valued within clinical dietetic practice, (ii) involves complex and multifactorial interactions, (iii) is perceived as having a positive influence, (iv) requires skills training and (v) is embedded in practice models and tools.ConclusionStudies show the therapeutic relationship is a valued and multifactorial component of clinical dietetic practice and is perceived to positively influence the client and dietitian. Observational data are needed to assess the extent to which the strength of the therapeutic relationship might contribute to clients' health outcomes.

Going Digital in a Pandemic! Transforming Dietetic Services by the use of digital platforms to deliver safe and sustainable care during COVID-19 and beyond

In April 2020, with the realisation that dietetic practice had to change when covering critical care units, a group of specialist dietitians led the development of a hand held digital dietetic record that could be safely use within the critical care unit avoiding the use of paper and it being transferred off the COVID critical care unit. Being digital enabled remote working, decreased footfall and increased safety for patients and staff. This was the first step in a journey that saw the transformation from a paper based system to one that is entirely digital across all dietetic areas within inpatient and outpatient settings and in both in adults and paediatrics by the end of 2020.

"Dietitians May Only Have One Chance"-The Realities of Treating Obesity in Private Practice in Australia.

Introduction: Overweight and obesity are the leading contributors to non-fatal burden of disease in Australia. Very low energy diets (VLEDs) comprising of meal replacement products (MRP) effectively induce substantial weight loss in people with obesity, yet they are rarely used as a first line treatment. Dietitians in private practice are perfectly placed to administer treatments for obesity; however, little is known about the preferred interventions used or their attitudes to incorporating VLEDs and MRPs into their treatments for overweight and obesity. Methods: This study used descriptive qualitative methods to explore accredited practicing dietitians’ (APDs’) perspectives and practices regarding obesity and obesity interventions, including the use of VLEDs and MRPs. Qualitative in-depth semi-structured interviews were conducted with 20 dietitians who had experience in private practice and in treating obesity. Transcribed interviews were analysed thematically using the technique of template analysis. Results: In the context within which dietitians’ practice was found to be a barrier to using evidence-based practice (EBP) for obesity treatment, four overarching themes were found. These were: (1) patient-centred care is the dietitians’ preferred intervention model; (2) VLEDs promote weight loss in specific situations; (3) systemic barriers constrain effective dietetic practice and equitable access to all, and (4) successful outcomes are predicated on working outside of systemic barriers. Conclusion: Dietitians in private practice are well placed and able to provide life-enhancing and evidence-based treatments for overweight and obesity and associated chronic disease in the community. However, systemic barriers need to be addressed to provide equitable access to effective care irrespective of socio-economic status.

UK dietitians' attitudes and experiences of formula very low- and low-energy diets in clinical practice.

SummaryDespite evidence that formula very low‐energy diets (VLED) and low‐energy diets (LED) are both effective and safe as treatments for obesity and type 2 diabetes, these diets remain underutilized in the United Kingdom. The aim of this study was to explore UK dietitians' attitudes and experiences of using formula VLED and LED. A cross‐sectional survey was disseminated between September 2019 and April 2020 through websites, social media platforms and dietetic networks using snowball sampling. In total, 241 dietitians responded to the online survey with 152 participants included in the final analysis (female [94.1%], mean age 40.8 years [SD 9.5]; median 12 years [interquartile range 8, 22] within dietetic practice). One hundred and nine (71.7%) participants reported currently using VLED/LED in clinical practice and 43 (28.3%) did not. Those with lower motivation and confidence in implementing VLED/LED in clinical practice were less likely to use them. Cost and adherence were the two highest reported barriers to use. Dietitians perceived VLED/LED were effective, but concerns remained about long‐term effectiveness, particularly for some patient groups. Dietitians also reported that further education, funding and service infrastructure, including access to clinic space and administrative support, were required to help embed VLED/LED into routine clinical practice. With clinical services now regularly offering VLED/LED programmes in the United Kingdom, dietitians are ideally placed to provide long‐term support. However, understanding, reporting and addressing the potential barriers (funding/infrastructure and education) appear to be key requirements in increasing the delivery of VLED/LED programmes nationally.