Dietitian Nutritionists Research Articles

Malnutrition Quality Improvement Initiative Data Support Continued Opportunities in Malnutrition Care.

Malnutrition remains prevalent among hospitalized patients in the United States and is associated with higher morbidity, mortality, and utilization costs when compared with individuals without malnutrition.1-3 Furthermore, estimates that malnutrition affects up to 60% of hospitalized older adults,4 yet continues to go unrecognized or undertreated,5 highlight a need to improve care for this patient population. Quality improvement can play an integral role in generating value-based solutions and provide a path for registered dietitian nutritionists (RDNs) to be at the forefront of improving malnutrition care.

Reprint of: Position of the Academy of Nutrition and Dietetics: Food Insecurity in the United States.

It is the position of the Academy of Nutrition and Dietetics that systematic and sustained action is needed to achieve food and nutrition security in the United States. To achieve food security, effective interventions are needed, along with adequate funding for, and increased utilization of, food and nutrition assistance programs; inclusion of nutrition education in such programs; strategies to support individual and household economic stability; and research to measure impact on food insecurity- and health-related outcomes. Millions of individuals living in the United States experience food insecurity. Negative nutritional and non-nutritional outcomes are associated with food insecurity across the lifespan, including substandard academic achievement, inadequate intake of key nutrients, increased risk for chronic disease, and poor psychological and cognitive functioning. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, play key roles in addressing food insecurity and are uniquely positioned to make valuable contributions through competent and collaborative practice, provision of comprehensive food and nutrition education and training, innovative research related to all aspects of food insecurity, and advocacy efforts at the local, state, regional, and national levels.

Impacting Malnutrition, Food Insecurity, and Health Equity: An Overview of Academy of Nutrition and Dietetics Priorities and Future Opportunities.

An inherent connection exists between malnutrition, food insecurity, and health equity. Registered dietitian nutritionists (RDNs) are at the forefront of addressing these to impact better health outcomes for the overall population in various practice settings (eg, hospital, post-acute and long-term care, community). Identifying malnutrition helps flag those who are food insecure and conversely, identifying food insecurity may suggest the presence or risk of malnutrition.1 The Academy of Nutrition and Dietetics (Academy) supports RDNs and nutrition and dietetic technicians, registered (NDTRs) by developing and providing tools, resources, and initiatives related to malnutrition, food insecurity, and health equity.

Patient Perception of Plant Based Diets for Kidney Disease

Plant-based diets can delay the progression of Chronic Kidney Disease (CKD) and help manage complications and co-morbid conditions such as hypertension, acidosis, diabetes and cardiovascular disease. The objective of this study was to understand nephrology patients' familiarity, perception and use of plant-based diets. & Methods: A survey was shared via the National Kidney Foundation's social media channels. Analysis included 844 responses. Survey items were evaluated with descriptive statistics. Differences across items were determined using chi-square tests. Most respondents were 61-70 years of age (26.7%, n=225), female (56.5%, n=477) and achieved a Bachelor's or advanced degree (49.9%, n=421). The majority of respondents suffered from non-dialysis dependent CKD (34%) or received a kidney transplant (34%). About half (45%) of respondents were familiar with plant-based diets and most (58%) were aware that plant-based diets can improve CKD. Twenty-two percent reported following some version of a vegetarian diet, and 29% reported "eating less meat". Respondents were not confident (Mdn=2, IQR=2, on a scale of 1-5) in their ability to plan a balanced plant-based meal, and were moderately confident that a plant-based diet could help blood pressure (Mdn=3, IQR=2) and slow progression of CKD (Mdn=3, IGR=2). Family eating preference, meal planning skills, preference for meat, figuring out what is healthy to eat, food cost, time constraints and ease of cooking were rated as equal barriers to following a plant based diet (Mdn=3). A sample meal plan, individual counseling session with a Registered Dietitian Nutritionist (RDN), handouts and cooking classes were resources rated most helpful to transition to a plant-based diet (Mdn=4). Approximately half of respondents were aware that plant-based diets can be beneficial for CKD. Many patients are following a vegetarian or plant-based eating pattern. More research should be done to see how effective RDNs are in educating and moving patients towards a plant-based eating pattern, as they are an underutilized resource in the CKD population.

Perceived Barriers of Nutrition Focused Physical Exam by Registered Dietitian Nutritionists Through Qualitative Responses

Perceived Barriers of Nutrition Focused Physical Exam by Registered Dietitian Nutritionists Through Qualitative Responses

A quasi-experimental study provides evidence that registered dietitian nutritionist care is aligned with the Academy of Nutrition and Dietetics evidence-based nutrition practice guidelines for type 1 and 2 diabetes.

BackgroundOne previous study examined implementation of evidence-based nutrition practice guidelines (EBNPG).ObjectivesTo describe alignment of registered dietitian nutritionists' (RDNs) documented nutrition care with the Academy of Nutrition and Dietetics' EBNPG for Type 1 and Type 2 diabetes and examine impact of a midpoint training on care alignment with the guideline.MethodsIn this 2-year, quasi-experimental study, 19 RDNs providing outpatient medical nutrition therapy to adults with diabetes (n = 562) documented 787 initial and follow-up encounters. At study midpoint, RDNs received a guideline content training. A validated, automated tool was used to match standardized nutrition care process terminology (NCPT) in the documentation to NCPT expected to represent guideline implementation. A congruence score ranging from 0 (recommendation not identified) to 4 (recommendation fully implemented) was generated based on matching. Multilevel linear regression was used to examine pre-to-post training changes in congruence scores.ResultsMost patients (~75%) had only one documented RDN encounter. At least one guideline recommendation was fully implemented in 67% of encounters. The recommendations “individualize macronutrient composition” and “education on glucose monitoring” (partially or fully implemented in 85 and 79% of encounters, respectively) were most frequently implemented. The mean encounter congruence scores were not different from pre-to-post guideline training (n = 19 RDNs, 519 encounters pre-training; n = 14 RDNs, 204 encounters post-training; β = −0.06, SE = 0.04; 95% CI: −0.14, 0.03).ConclusionsMost RDN encounters had documented evidence that at least one recommendation from the EBNPG was implemented. The most frequently implemented recommendations were related to improving glycemic control. A midpoint guideline training had no impact on alignment of care with the guideline.

Nutrition-Related Knowledge Is Needed Among Community-Dwelling Traumatic Brain Injury Survivors and their Caregivers: A Focus Group Study

Registered Dietitian Nutritionists need to provide nutritional information and resources to help caregivers identify strategies for improving nutritional care for their love one with traumatic brain injury.

Attending a Pre-Op Class with a Nutrition Component Taught by a Registered Dietitian Nutritionist Increases Patients Perioperative Protein Intake

Attending a Pre-Op Class with a Nutrition Component Taught by a Registered Dietitian Nutritionist Increases Patients Perioperative Protein Intake

Nutrition Research Funding Trends and Focus Areas at the US National Cancer Institute.

Evidence for diet and nutrition's role in the cancer continuum is inconsistent and requires further study. Although more investigation is needed, the National Cancer Institute (NCI) funding for nutrition has decreased. To examine nutrition research funding at the NCI, a portfolio analysis was undertaken for fiscal year (FY) 2018. Nutrition and other cancer-related terms were searched using the National Institutes of Health Query View and Report grants management dashboard. Grants were categorized by mechanism, funding status, applicant characteristics, funding opportunity announcement type, award type, and study characteristics. A total of 18 233 NCI grant applications were submitted in FY 2018; 12% were funded. Of the 653 nutrition-related grant applications received, 69 (11%) were funded. Funding status of nutrition grants did not differ statistically based on the type of funding opportunity announcement and were higher for applications classified as investigator initiated. Early stage investigators' nutrition applications were funded less than other investigators. Only 4% and 6% of overall and funded nutrition grant applications were submitted by registered dietitian nutritionist primary investigators, respectively. Average FY 2018 award amounts for funded nutrition and overall grant applications were approximately US $399 000 and approximately US $703 000, respectively. Although the percentage of NCI nutrition grants funded was similar to other grant funding at NCI in FY 2018, between FY 2012 and FY 2018, NCI decreased overall nutrition funding by 44%. Average grant award amounts for nutrition were less compared with overall NCI-funded grant applications and other topics. Our analysis highlights potential opportunities for greater investment in nutrition research at the NCI.

Breaking Barriers: The Impact of Diversity on Career Transformations for Registered Dietitian Nutritionists

Upon completion, the participant will be able to identify barriers and successes associated with diversity related issues of age, gender and race/ethnicity on the career transformations of Registered Dietitian Nutritionists.

Weight Status Outcomes among Oncology Patients Seen by Registered Dietitian Nutritionists

Weight Status Outcomes among Oncology Patients Seen by Registered Dietitian Nutritionists

Career Readiness of Recently Credentialed Registered Dietitian Nutritionists

Career Readiness of Recently Credentialed Registered Dietitian Nutritionists

RDs and FPs: Highlights of the Collaborative Practice between Registered Dietitian Nutritionists and Family Partners in the Pediatric Pulmonary Center Leadership Training Programs

Describe the role of Family Partners in Interprofessional Health care teams and how they collaborate with registered dietitian nutritionists and trainees in Pediatric Pulmonary Center Leadership Training Programs

Embracing the Virtual Care Paradigm: Dietitians Preference and Increased Utilization of Telehealth

Upon completion participants will be able to describe the roles Registered Dietitian Nutritionists (RDNs) play in providing successful virtual nutrition counseling for oncology patients during the COVID pandemic and beyond.

Weight Status Outcomes among Oncology Patients Seen by Registered Dietitian Nutritionists

Weight Status Outcomes among Oncology Patients Seen by Registered Dietitian Nutritionists

Influences on Health Behaviors of Registered Dietitian Nutritionist during the COVID-19 Pandemic

Influences on Health Behaviors of Registered Dietitian Nutritionist during the COVID-19 Pandemic

Academy of Nutrition and Dietetics: Revised 2022 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Public Health and Community Nutrition

Awareness of the social determinants of health has been increasing in recent years. These include equitable access to health care and foods that support healthy eating patterns. A wide range of issues related to these determinants influence practice in the public health and community nutrition field. In response to these evolving needs, the Public Health and Community Nutrition Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, has developed Standards of Practice and Standards of Professional Performance as a tool for Registered Dietitian Nutritionist (RDNs) currently in practice or interested in working in public health and community nutrition, to assess their current skill levels and to identify areas for professional development. The Standards of Practice address the four steps of the Nutrition Care Process for community and public health RDNs: assessment, diagnosis, intervention, and evaluation/monitoring. The Standards of Professional Performance consists of six domains of professional performance for community and public health RDNs: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Within each standard, specific indicators provide measurable action statements that illustrate the ways in which RDNs can address population nutrition and health. The indicators describe three skill levels (Competent, Proficient, and Expert) for RDNs. These tools highlight the unique scope of expertise that RDNs provide to the field of public health and community nutrition.

Repeated Cross-Sectional Surveys of Registered Dietitian Nutritionists Demonstrate Rapid Practice Changes to Address Food Insecurity During the Coronavirus Disease 2019 Pandemic

BackgroundThe coronavirus disease 2019 pandemic had worldwide economic impact, exacerbating food insecurity risk for vulnerable populations. ObjectiveTo describe changes in practice and challenges and areas of need related to addressing food insecurity during the coronavirus disease 2019 pandemic for registered dietitian nutritionist survey respondents. DesignA cross-sectional, anonymous, online survey distributed via the Academy of Nutrition and Dietetics e-mail communication platform and social media accounts from April through May 2020 (Wave 1 [W1]) and December 2020-February 2021 (Wave 2 [W2]). Participants and settingParticipants were US-based registered dietitian nutritionists practicing in community-based settings to address food insecurity (W1: n = 454; W2: n = 331). Statistical analysesResponses were descriptively summarized using means ± SD, medians and interquartile ranges, or number of observations and percentages. Open-ended responses were manually reviewed and organized into major themes. ResultsRespondents had about 10 years of experience in addressing food insecurity and were most commonly involved with the Special Supplemental Nutrition Program for Women, Infants and Children, federal school nutrition programs, or food banks. Participants described increased demand for food security assistance (W1: 68%; W2: 60%). Among respondents involved in food preparation and handling (W1: n = 183; W2: n = 110), supply chain (W1: 61%; W2: 56%) and staffing (W1: 37%; W2: 50%) challenges were commonly reported. Child nutrition program professionals (W1: n = 143; W2: n = 84) reported widespread implementation of optional program waivers, with the most commonly implemented waivers allowing noncongregate meal service (W1: 83%; W2: 81%), caregivers to pick up meals (W1: 69%; W2: 85%), and flexibility in mealservice times (W1: 75%; W2: 87%). ConclusionsRespondents quickly adapted programs to ensure staff and client safety while continuing to provide essential food security services. They identified the need for ongoing nutrition program policy advocacy and timely access to best practice resources during public health emergencies.

Interassociation Consensus Statement on Sports Nutrition Models for the Provision of Nutrition Services From Registered Dietitian Nutritionists in Collegiate Athletics.

Collegiate athletic programs are increasingly adding nutrition services to interdisciplinary sports medicine and sports performance departments in response to scientific evidence highlighting nutrition's integral role in supporting athletic performance and overall health. Registered Dietitian Nutritionists (RDNs) specializing in sports dietetics (ie, sports RDNs) and credentialed Board-certified Specialists in Sports Dietetics (CSSDs) are the preferred nutrition service providers for these programs. Their extensive training and proficiency in medical nutrition therapy, education and behavioral counseling, food-service management, exercise physiology, physical performance, and administration, as defined by the "Standards of Practice and "Standards of Professional Performance" for Registered Dietitian Nutritionists in Sports Nutrition and Human Performance," make these practitioners uniquely qualified to deliver the breadth of care required in the collegiate setting. Therefore, this document, guided by a multidisciplinary panel, introduces 4 sports nutrition models through which any collegiate athletic program can deliver sports RDN-directed nutrition services. In each model, the most effective staffing and scope of service are indicated and reviewed. In addition, recommended organizational structures for sports RDNs are provided that best support the delivery of the model's nutrition services in a variety of collegiate athletic programs and organizational settings. Lastly, future research initiatives and nutrition interventions to help improve the standard of care through these sport nutrition models are explored.

The feasibility and acceptability of a dementia care training program for registered dietitian nutritionists

ABSTRACT There is a need for more Registered Dietitian Nutritionists (RDNs) trained to provide nutritional care to older adults with dementia who experience mealtime difficulties. The purpose of this single-arm, pre/post pilot study was to adapt a generalized dementia care curriculum to the learning needs of RDNs who work with individuals with dementia and to determine the feasibility and acceptability of the adapted program. Using an existing evidence-based dementia care curriculum, the research team identified learning objectives and content pertinent to the scope of RDNs. The adapted program was piloted with RDNs who work with older adults with dementia. Twenty-five RDNs registered for the training while 80% (20) attended the training and completed the post-training survey. All participants agreed that the module met the learning needs of RDNs who work with older adults with dementia, the two-hour workshop was a good use of their time, and the experience and skills gained would be useful in their work as an RDN. Implementation costs totaled $1,310. Based on the post-training feedback, the adapted program was deemed feasible and acceptable by RDN participants, who also expressed interest in using the module to train other caregivers on providing mealtime assistance to older adults with dementia.