Evidence-Based Nutrition Practice Guideline Research Articles

Prevention and Treatment of Malnutrition in Older Adults Living in Long-Term Care or the Community: an Evidence-based Nutrition Practice Guideline

Malnutrition in older adults can decrease quality of life and increase risk of morbidities and mortality. Accurate and timely identification of malnutrition, as well as subsequent implementation of effective interventions, are essential to decrease poor outcomes associated with malnutrition in older adults. The Academy of Nutrition and Dietetics Evidence Analysis Center conducted a systematic review of the literature to develop an evidence-based nutrition practice guideline for the prevention and treatment of malnutrition in older adults. The objective of this guideline was to provide evidence-based recommendations to identify, prevent, or treat protein-energy malnutrition in older adults (mean age ≥65 years) living in long-term care and community settings. This guideline provides 11 nutrition recommendations to inform shared decision making among dietitians, members of the health care team, family members or caregivers, and older adults living in long-term care or the community to prevent or treat malnutrition. Topics include dietitian effectiveness, nutrition assessment tools, oral nutrition supplements, food fortification, and home-delivered and congregate meals. Guideline implementation should include consideration of the importance of comprehensive individualized nutrition care for older adults. Future research is needed to address gaps that were identified related to the validity, reliability, and feasibility of nutrition assessment tools, as well as the effectiveness of dietitian interventions on outcomes of interest in older adults living in long-term care and the community.

Saturated Fat Intake and the Prevention and Management of Cardiovascular Disease in Adults: An Academy of Nutrition and Dietetics Evidence-Based Nutrition Practice Guideline.

Cardiovascular disease (CVD) is the leading cause of death in the United States and globally and is largely attributable to atherosclerosis. Evidence indicates that multiple dietary components contribute to the complex causes of CVD and associated events and mortality. Public health authorities and scientific organizations have recommended reduced saturated fatty acid (SFA) intake for decades to promote cardiovascular health, which is linked to favorable impacts on established and emerging atherosclerotic CVD risk factors. Recently, a debate has emerged about whether SFA intake should be reduced for CVD prevention, which has contributed to confusion among health care professionals, including registered dietitian nutritionists (RDNs), and the general public, and necessitates the critical evaluation of the evidence. The objective of this evidence-based nutrition practice guideline is to provide health care and public health professionals, particularly RDNs, with evidence-based recommendations on how to address SFA intake in adults within an individualized healthy dietary pattern. Moderate evidence supports the reduction of SFA intake for CVD event reduction, low- to moderate-certainty evidence supports prioritization of replacement of SFAs with polyunsaturated fatty acids, and low-certainty evidence supports focusing on reducing the total amount of SFA rather than specific food sources of SFA. Guideline implementation should include consideration of individual preferences; principles of inclusion, diversity, equity, and access; and potential nutritional deficiencies that may occur with reduced SFA intake. Future research is needed to address gaps that were identified and provide high-quality evidence to support stronger future recommendations based on the relationship between SFA and CVD.

Celiac Disease: An Academy of Nutrition and Dietetics Evidence-Based Nutrition Practice Guideline.

Celiac disease is an autoimmune disorder in which the immune system of genetically susceptible individuals elicits a reaction to gluten causing small intestine damage. If left undiagnosed and untreated, the resulting nutrition malabsorption can lead to anemia, bone disease, growth faltering, or other consequences. The condition is lifelong and lacks a cure; the only treatment is lifelong adherence to a gluten-free diet (GFD). This diet is challenging to follow and adversely influences quality of life; however, it is essential to ensure intestinal recovery and prevent future negative health consequences. The Academy of Nutrition and Dietetics convened an expert panel complemented by a celiac disease patient advocate to evaluate evidence for six topics, including medical nutrition therapy; the GFD; oat consumption; micronutrients; pro-/prebiotics; and the low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet. This publication outlines the Academy of Nutrition and Dietetics Evidence Analysis Library methods used to complete the systematic review and guideline development, and summarizes the recommendations and supporting evidence. The guidelines affirm that all individuals with celiac disease should follow a GFD (1C, Imperative) that may include gluten-free oats in adults (2D, Conditional). Children should follow a nutritionally adequate GFD that supports healthy growth and development (Consensus, Imperative) and does not unnecessarily restrict gluten-free oats (Consensus, Conditional). The guidelines indicate nutritional care should include routine nutritional assessment (Consensus, Imperative) and medical nutrition therapy (Consensus, Imperative). At this time, the guidelines do not support a recommendation for the addition of the low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet (2C, Conditional); prebiotic or probiotic supplementation (2D, Conditional); or micronutrient supplementation (in the absence of nutritional deficiency) (Consensus, Conditional). The 2021 Celiac Disease Evidence-Based Nutrition Guideline will assist registered dietitian nutritionists in providing appropriate evidence-based medical nutrition therapy to support people with celiac disease in achieving and maintaining nutritional health and avoiding adverse celiac disease consequences throughout their lives.

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.

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.

Evaluating the Implementation of Evidence-based Kidney Nutrition Practice Guidelines: The AUGmeNt Study Protocol

Evidence-based nutrition practice guidelines (EBNPGs) inform registered dietitian nutritionist (RDN) care for patients with chronic kidney disease grade 5 treated by dialysis; however, there has been little evaluation of best practices for implementing EBNPGs. In this effectiveness-implementation hybrid study with a quasi-experimental design, United States RDNs in hemodialysis clinics will document initial and follow-up nutrition care for patients with chronic kidney disease grade 5 treated by dialysis using the Academy of Nutrition and Dietetics Health Informatics Infrastructure before and after being randomly assigned to a training model: (1) EBNPG knowledge training or (2) EBNPG knowledge training plus an implementation toolkit. The aims of the study include examining congruence of RDN documentation of nutrition care with the EBNPG; describing common RDN-reported EBNPG acceptability, adoption, and adaptation issues; and determining the feasibility of estimating the impact of RDN care on nutrition-related patient outcomes. The AUGmeNt study can inform effective development and implementation of future EBNPGs. Keywords: Chronic kidney diseases; medical nutrition therapy; implementation science; clinical practice guideline; nutrition care process terminology; dietitian.

Academy of Nutrition and Dietetics Nutrition Research Network: Validation of a Novel Nutrition Informatics Tool to Assess Agreement Between Documented Nutrition Care and Evidence-Based Recommendations

More evidence regarding registered dietitian nutritionist implementation of evidence-based nutrition practice guidelines (EBNPGs) is needed. We assessed the utility of an automated informatics tool to evaluate congruence of documented nutrition care with 13 individual recommendations in the diabetes mellitus (DM) EBNPG and with the guideline overall. A concurrent validation study was conducted using Nutrition Care Process Terminology documentation entered in the Academy of Nutrition and Dietetics Health Informatics Infrastructure by registered dietitian nutritionists caring for patients with DM. A 15% subset (n = 115) of the 790 patient encounters recorded were selected randomly, and the documented care was evaluated using the automated DM Expected Care Plan (ECP) Analyzer and expert audit. Recommendation-level congruence, as determined by each method, was compared using Cohen’s κ analysis, and the accuracy, sensitivity, and specificity of the DM ECP Analyzer for assessing overall guideline-level congruence was calculated with expert audits as the “gold standard.” For recommendation-level congruence, the DM ECP Analyzer identified more instances of recommendation implementation in the patient encounters, and classified more encounters as including partial or full recommendation implementation for 10 of the 13 recommendations, compared with the expert audit. There was slight to fair agreement between the DM ECP and the expert audit for most individual recommendations, with a mean ± standard deviation level of agreement of κ = .17 ± .19 across all eligible recommendations. At the guideline level, the DM Analyzer had high accuracy (98.3%) and sensitivity (99.1%) and low specificity (0%; no true negatives detected). The DM ECP Analyzer is acceptable for conducting automated audits of nutrition documentation to assess congruence of documented care with recommendations for evidence-based care. Future changes to the EBNPG, Nutrition Care Process Terminology, Academy of Nutrition and Dietetics Health Informatics Infrastructure, and the DM ECP Analyzer could potentially improve recommendation-level performance. The DM ECP Analyzer can be modified for other EBNPGs to facilitate automated assessment of guideline implementation.

Very Low Birthweight Preterm Infants: A 2020 Evidence Analysis Center Evidence-Based Nutrition Practice Guideline.

The National Institutes for Health and the Academy of Nutrition and Dietetics initiated the “Pre-B Project” to address the lack of very low birth weight (VLBW) preterm infant evidence-based nutrition practice guidelines. A scoping review and nine systematic reviews on enteral nutrition interventions were conducted by a multidisciplinary Preterm Panel. Recommendations were developed using the Academy’s Evidence Analysis Center Process and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence-to-Decision framework.

Impact of Diabetes Prevention Guideline Adoption on Health Outcomes: A Pragmatic Implementation Trial

Limited research exists to evaluate nutrition guideline impact on clinical practice and patient health outcomes. In this study we investigate (1) the impact of guideline training on the implementation of the diabetes prevention Evidence-Based Nutrition Practice Guideline (EBNPG), and (2) the relationship between EBNPG congruence and resulting health outcomes in patients with prediabetes. We conducted an implementation study in which registered dietitian nutritionists (RDNs) provided nutrition care with 3-month follow-up to 102 pre-diabetes patients before and after a professional training on the implementation of the Diabetes Prevention EBNPG. Using the RDNs' Nutrition Care Process (NCP) documentation, we measured percent guideline congruence and health outcomes (body weight, waist circumference, fasting glucose, glycosylated hemoglobin), and modeled health outcomes. Guideline congruence improved after training by 4.3% (P < 0.05). However, no significant associations were observed between guideline training, or guideline congruence and health outcomes. Our model showed a reduction in waist circumference (2.1 ± 0.92 cm; P= 0.023), and body weight (-1.78 ± 0.55 kg; P= 0.001) throughout the course of the study. Training of nutrition professionals improved congruence to EBNPG for Diabetes Prevention. Nevertheless, improved guideline congruence did not impact related health outcomes. Standard care including nutrition intervention resulted in body weight and waist circumference reductions. Future research needs to further address the impact of evidence-based guidelines on outcomes in all areas of practice.

Evolving the Academy Position Paper Process: Commitment to Evidence-Based Practice

The Academy of Nutrition and Dietetics (Academy) is dedicated to supporting evidence-based practice and recommends that nutrition and dietetics practitioners utilize evidence-based principles and current scientific evidence within their practice. To assist practitioners in achieving this, the Academy provided members with resources, including Evidence-Based Nutrition Practice Guidelines (EBNPGs), systematic reviews, position papers, and practice papers. These resources were designed to inform Academy members of the latest research on specific topics in the field of nutrition and to assist with implementation of evidence-based principles into daily practice. D. Handu is a senior scientist, Evidence Analysis Center Operations, Academy of Nutrition and Dietetics, Chicago, IL. L. Moloney is a nutrition researcher, Evidence Analysis Center Operations, Academy of Nutrition and Dietetics, Chicago, IL. M. R. Rozga is a nutrition researcher, Evidence Analysis Center Operations, Academy of Nutrition and Dietetics, Chicago, IL. F. Cheng is a nutrition researcher, Evidence Analysis Center Operations, Academy of Nutrition and Dietetics, Chicago, IL. D. Wickstrom is formerly research manager, Evidence Analysis Center Operations, Academy of Nutrition and Dietetics, Chicago, IL. A. Acosta is director, Evidence Analysis Center Operations, Academy of Nutrition and Dietetics, Chicago, IL.

Medical Nutrition Therapy for Patients with Non–Dialysis-Dependent Chronic Kidney Disease: Barriers and Solutions

Medical Nutrition Therapy for Patients with Non–Dialysis-Dependent Chronic Kidney Disease: Barriers and Solutions

Nutrition Assessment, Exposures, and Interventions for Very-Low-Birth-Weight Preterm Infants: An Evidence Analysis Center Scoping Review

Annually, 15 million infants, or approximately 1 of every 10, are born before term, 1 Centers for Disease Control and Prevention. Preterm Birth 2017. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm. Accessed September 9, 2017. Google Scholar , 2 World Health Organization. Preterm Birth. http://www.who.int/mediacentre/factsheets/fs363/en/. Accessed September 6, 2017. Google Scholar leading to short- and long-term health consequences such as infection, growth concerns, developmental impairment, and other comorbidities. 3 Institute of Medicine. 2007. Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: The National Academies Press. https://doi.org/10.17226/11622. Accessed May 25, 2017. Google Scholar , 4 Platt M.J. Outcomes in preterm infants. Public Health. 2014; 128: 399-403 Crossref PubMed Scopus (123) Google Scholar Nutrition interventions may address some effects of prematurity. However, current, comprehensive, evidence-based nutrition practice guidelines (EBNPGs) for preterm infants are lacking in the literature. 5 Raiten D.J. Steiber A.L. Carlson S.E. et al. Working group reports: Evaluation of the evidence to support practice guidelines for nutritional care of preterm infants-the Pre-B Project. Am J Clin Nutr. 2016; 103: 648S-678S Crossref PubMed Scopus (24) Google Scholar , 6 Raiten D.J. Steiber A.L. Hand R.K. Executive summary: Evaluation of the evidence to support practice guidelines for nutritional care of preterm infants-the Pre-B Project. Am J Clin Nutr. 2016; 103: 599S-605S Crossref PubMed Scopus (20) Google Scholar Existing guidelines for preterm infants are not based on comprehensive systematic reviews (SRs) and may not represent the current population of preterm infants seen in the neonatal intensive care unit (NICU), which include smaller and less developmentally mature infants. 5 Raiten D.J. Steiber A.L. Carlson S.E. et al. Working group reports: Evaluation of the evidence to support practice guidelines for nutritional care of preterm infants-the Pre-B Project. Am J Clin Nutr. 2016; 103: 648S-678S Crossref PubMed Scopus (24) Google Scholar In addition, treatment options for preterm infants are continually evolving, and current guidelines must address relevant practices in the NICU. L. Moloney is nutrition researcher at the Academy of Nutrition and Dietetics, Chicago, IL. M. Rozga is nutrition researcher at the Academy of Nutrition and Dietetics, Chicago, IL. T. R. Fenton is nutrition research lead, Nutrition Services, Alberta Health Services, and associate professor, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

Position of the Academy of Nutrition and Dietetics: The Role of Medical Nutrition Therapy and Registered Dietitian Nutritionists in the Prevention and Treatment of Prediabetes and Type 2 Diabetes

It is the position of the Academy of Nutrition and Dietetics that for adults with prediabetes or type 2 diabetes, medical nutrition therapy (MNT) provided by registered dietitian nutritionists (RDNs) is effective in improving medical outcomes and quality of life, and is cost-effective. MNT provided by RDNs is also successful and essential to preventing progression of prediabetes and obesity to type 2 diabetes. It is essential that MNT provided by RDNs be integrated into health care systems and public health programs and be adequately reimbursed. The Academy’s evidence-based nutrition practice guidelines for the prevention of diabetes and the management of diabetes document strong evidence supporting the clinical effectiveness of MNT provided by RDNs. Cost-effectiveness has also been documented. The nutrition practice guidelines recommend that as part of evidence-based health care, providers caring for individuals with prediabetes or type 2 diabetes should be referred to an RDN for individualized MNT upon diagnosis and at regular intervals throughout the lifespan as part of their treatment regimen. Standards of care for three levels of diabetes practice have been published by the Diabetes Care and Education Practice Group. RDNs are also qualified to provide additional services beyond MNT in diabetes care and management. Unfortunately, barriers to accessing RDN services exist. Reimbursement for services is essential. Major medical and health organizations have provided support for the essential role of MNT and RDNs for the prevention and treatment of type 2 diabetes.

Implementing Evidence-Based Nutrition Practice Guidelines for Type 2 Diabetes Mellitus in Lebanon

Lebanon is a Middle Eastern country experiencing a surge in the prevalence of type 2 diabetes mellitus among adults. This pilot study evaluated the feasibility and outcomes of implementing the Academy of Nutrition and Dietetics Evidence-Based Nutrition Practice Guidelines (EBNPGs) as part of medical care for patients newly diagnosed with type 2 diabetes mellitus. Seventy-five patients were recruited from 3 Lebanese hospitals, received nutrition care according to EBNPGs, and were followed up for 12 months. Patients achieved significant improvement in clinical outcomes between baseline and 3, 6, and 12 months. Further research is recommended to confirm the benefits of using EBNPGs.

2015 Evidence Analysis Library Evidence-Based Nutrition Practice Guideline for the Management of Hypertension in Adults

Hypertension (HTN) or high blood pressure (BP) is among the most prevalent forms of cardiovascular disease and occurs in approximately one of every three adults in the United States. The purpose of this Evidence Analysis Library (EAL) guideline is to provide an evidence-based summary of nutrition therapy for the management of HTN in adults aged 18 years or older. Implementation of this guideline aims to promote evidence-based practice decisions by registered dietitian nutritionists (RDNs), and other collaborating health professionals to decrease or manage HTN in adults while enhancing patient quality of life and taking into account individual preferences. The systematic review and guideline development methodology of the Academy of Nutrition and Dietetics were applied. A total of 70 research studies were included, analyzed, and rated for quality by trained evidence analysts (literature review dates ranged between 2004 and 2015). Evaluation and synthesis of related evidence resulted in the development of nine recommendations. To reduce BP in adults with HTN, there is strong evidence to recommend provision of medical nutrition therapy by an RDN, adoption of the Dietary Approaches to Stop Hypertension dietary pattern, calcium supplementation, physical activity as a component of a healthy lifestyle, reduction in dietary sodium intake, and reduction of alcohol consumption in heavy drinkers. Increased intake of dietary potassium and calcium as well as supplementation with potassium and magnesium for lowering BP are also recommended (fair evidence). Finally, recommendations related to lowering BP were formulated on vitamin D, magnesium, and the putative role of alcohol consumption in moderate drinkers (weak evidence). In conclusion, the present evidence-based nutrition practice guideline describes the most current recommendations on the dietary management of HTN in adults intended to support the practice of RDNs and other health professionals.

Insights From the Diabetes in India Nutrition Guidelines Study

This 12-month prospective randomized cluster trial of 20 dietitians in India compared usual care (UC) and evidence-based nutrition practice guideline (EBNPG) care for patients with type 2 diabetes mellitus. Baseline, 6-month, and 12-month data from 238 patients were analyzed. EBNPG implementation was evaluated using the Ottawa Model for Knowledge Transfer. EBNPG and UC groups achieved significant hemoglobin A1C improvements. EBNPG-treated participants were significantly more likely to meet low-density lipoprotein, high-density lipoprotein, and triglyceride goals at 6 or 12 months. Dietitian dropout, implementation barriers, and undetermined EBNPG intervention fidelity are limitations. Future research should assess barriers/supports and degree of EBNPG use.

Assessing the Viability of Social Media for Disseminating Evidence-Based Nutrition Practice Guideline Through Content Analysis of Twitter Messages and Health Professional Interviews: An Observational Study.

BackgroundGiven the high penetration of social media use, social media has been proposed as a method for the dissemination of information to health professionals and patients. This study explored the potential for social media dissemination of the Academy of Nutrition and Dietetics Evidence-Based Nutrition Practice Guideline (EBNPG) for Heart Failure (HF).ObjectivesThe objectives were to (1) describe the existing social media content on HF, including message content, source, and target audience, and (2) describe the attitude of physicians and registered dietitian nutritionists (RDNs) who care for outpatient HF patients toward the use of social media as a method to obtain information for themselves and to share this information with patients.MethodsThe methods were divided into 2 parts. Part 1 involved conducting a content analysis of tweets related to HF, which were downloaded from Twitonomy and assigned codes for message content (19 codes), source (9 codes), and target audience (9 codes); code frequency was described. A comparison in the popularity of tweets (those marked as favorites or retweeted) based on applied codes was made using t tests. Part 2 involved conducting phone interviews with RDNs and physicians to describe health professionals’ attitude toward the use of social media to communicate general health information and information specifically related to the HF EBNPG. Interviews were transcribed and coded; exemplar quotes representing frequent themes are presented.ResultsThe sample included 294 original tweets with the hashtag “#heartfailure.” The most frequent message content codes were “HF awareness” (166/294, 56.5%) and “patient support” (97/294, 33.0%). The most frequent source codes were “professional, government, patient advocacy organization, or charity” (112/277, 40.4%) and “patient or family” (105/277, 37.9%). The most frequent target audience codes were “unable to identify” (111/277, 40.1%) and “other” (55/277, 19.9%). Significant differences were found in the popularity of tweets with (mean 1, SD 1.3 favorites) or without (mean 0.7, SD 1.3 favorites), the content code being “HF research” (P=.049). Tweets with the source code “professional, government, patient advocacy organizations, or charities” were significantly more likely to be marked as a favorite and retweeted than those without this source code (mean 1.2, SD 1.4 vs mean 0.8, SD 1.2, P=.03) and (mean 1.5, SD 1.8 vs mean 0.9, SD 2.0, P=.03). Interview participants believed that social media was a useful way to gather professional information. They did not believe that social media was useful for communicating with patients due to privacy concerns and the fact that the information had to be kept general rather than be tailored for a specific patient and the belief that their patients did not use social media or technology.ConclusionsExisting Twitter content related to HF comes from a combination of patients and evidence-based organizations; however, there is little nutrition content. That gap may present an opportunity for EBNPG dissemination. Health professionals use social media to gather information for themselves but are skeptical of its value when communicating with patients, particularly due to privacy concerns and misconceptions about the characteristics of social media users.

Dietetic management of gestational diabetes in New Zealand: A cross-sectional survey.

The aim of this study was to evaluate dietetic practice in the management of gestational diabetes in New Zealand, compare this with evidence-based guidelines and determine the need for New Zealand-specific evidence-based nutrition practice guidelines for gestational diabetes. A 64-item cross-sectional online survey of New Zealand-registered dietitians providing care to women with gestational diabetes was undertaken. Participants were recruited through Dietitians New Zealand, District Health Boards and private practices across New Zealand. The survey examined dietetic service provision, management recommendations, guideline use, service evaluation, compliance with national and international guidelines and the perceived need for New Zealand-specific evidence-based guidelines for the nutritional management of gestational diabetes. Thirty-three (62%) eligible dietitians participated in the survey. There was significant variation in dietetic services and management recommendations. Nine (28%) dietitians felt the service within which they worked did not offer adequate dietetic services for women with gestational diabetes. Compliance with national and international evidence-based guidelines ranged from 28 to 100% depending on the recommendation. Twenty-five (76%) respondents felt there was a need for New Zealand-specific evidence-based nutrition practice guidelines for gestational diabetes. These results highlight differences in dietetic services and practice in New Zealand and variations in compliance with local and international evidence-based guidelines. The development of New Zealand-specific evidence-based nutrition practice guidelines for gestational diabetes is supported.

Academy of Nutrition and Dietetics Methodology for Developing Evidence-Based Nutrition Practice Guidelines

The growing volume of health-related research presents a practical challenge for practitioners. It is difficult to stay current with the latest scientific information, and controversy about bias or applicability of research to specific populations will often complicate matters further. Many practitioners recognize the need for current, substantive guidance to provide state-of-the-art care. In line with this trend, the National Academy of Medicine (formerly Institute of Medicine) supports that quality health care must be evidence-based. 1 Institute of Medicine Committee on Quality of Health Care in ACrossing the Quality Chasm: A New Health System for the 21st Century. The National Academies Press, Washington, DC2001 Google Scholar In the last 20 years, practitioners have moved steadily toward using evidence-based guidelines as blueprints to inform practice and facilitate tailored decision making. 2 Institute of MedicineClinical Practice Guidelines We Can Trust. The National Academies Press, Washington, DC2011 Google Scholar Evidence-based guidelines are expected to help busy practitioners locate relevant information rapidly, make a case for the best treatment available, and document the outcomes that third-party payers rely on. Since 2004, the Academy of Nutrition and Dietetics (Academy) has conducted systematic evidence reviews, 3 Handu D. Moloney L. Wolfram T. Ziegler P. Acosta A. Steiber A. Academy of Nutrition and Dietetics Methodology for Conducting Systematic Reviews for the Evidence Analysis Library. J Acad Nutr Diet. 2016; 116: 311-318 Abstract Full Text PDF PubMed Scopus (87) Google Scholar which are, in turn, used to develop evidence-based nutrition practice guidelines (EBNPGs) as an essential strategy to bridge the gap between research and practice in nutrition care. C. Papoutsakis is nutrition researcher, level II, Evidence-Analysis Library Business Operations, Academy of Nutrition and Dietetics, Chicago, IL. L. Moloney is evidence-based practice manager, Evidence-Analysis Library Business Operations, Academy of Nutrition and Dietetics, Chicago, IL. R. C. Sinley is nutrition researcher, level I, Evidence-Analysis Library Business Operations, Academy of Nutrition and Dietetics, Chicago, IL. A. Acosta is senior manager, Evidence-Analysis Library Business Operations, Academy of Nutrition and Dietetics, Chicago, IL. D. Handu is lead analyst/project manager, Academy of Nutrition and Dietetics, Chicago, IL. A. L. Steiber is chief science officer, Academy of Nutrition and Dietetics, Chicago, IL.

Oncology Evidence-Based Nutrition Practice Guideline for Adults

Oncology Evidence-Based Nutrition Practice Guideline for Adults