Dietetic Practice Research Articles

Fecal Microbiota Transplantation to Prevent and Treat Chronic Disease: Implications for Dietetics Practice

The incidence of chronic disease is a growing public health concern because 133 million Americans live with at least one condition.1 Chronic disease is costly to treat, altogether accounting for 75% of US health care spending and it is the country’s leading cause of mortality.1 A multitude of factors are responsible for the increasing prevalence of chronic health conditions. One such factor believed to influence the development of chronic conditions is the gut microbiome.2 Rehabilitating the microbiome can alleviate pain associated with chronic conditions and reduce the cost of symptom management.

Nutrition Capacity Building to Meet National Priorities: Lessons Learned in Developing and Implementing Malawi's First Dietetics Program.

The current nutrition situation in Malawi, characterized by high rates of malnutrition in communities and hospitals and a rapidly increasing burden of overweight/obesity and diet-related noncommunicable diseases, highlights the urgent need for registered dietitians, who have a proven track record in the prevention and management of all forms of malnutrition and improving patient outcomes. However, dietetics practice has been described as underdeveloped and fragmented in many parts of Africa, exacerbated by a severe and chronic shortage of dietetics professionals and a lack of nutrition and dietetic education programs in most African countries.We share early lessons learned in the development and implementation of the first dietetics program in Malawi. Within 6 years, the program produced 10 graduate dietitians who have filled the first clinical dietitian posts in Malawian public hospitals. This early success can be attributed to the model used to develop and implement the program, which included early stakeholder engagement to define the priority skills and competencies of a Malawian dietitian, the use of internationally recognized training standards, and the development of strategic institutional partnerships that brought together complementary skills and expertise. Furthermore, using existing resources and recruiting students with a nutrition and health background accelerated implementation. The current dietetics curriculum responds to the national nutrition and health policy direction and strategic objectives. Early and sustained government engagement was crucial in creating demand and securing career prospects for graduates. Although still in its infancy, dietitians in Malawi are poised to contribute significantly to alleviating the country's complex nutrition challenges.

From tensions to transformation: Teaching food systems in a graduate dietetics course

Dietitians are deeply embedded within food systems, so food systems concepts are becoming an essential component of dietetic education in Canada. Yet how can we, as educators, better prepare future dietitians to embrace the complexity of food systems and be forces of change towards equity? In an effort to explore this question in a practical way, we integrated food systems concepts into a mandatory course of a public health graduate dietetics program. This field report shares our experiences teaching food systems over five years based on our notes kept, student feedback, and course evaluations. Our learnings have been in three key areas: intentions, facilitation, and tensions.
 We recognized that teaching about food systems is value-laden. Hence we have been explicit with the students about our positionality and our intentions in designing the course, partly to meet the management of food systems competency requirements, but also to stimulate thinking about alternative options for purpose, structures, and processes in food systems. Our facilitation approaches aimed to foster a critical consciousness towards social justice and systems change. Using teaching and evaluation methods such as experiential learning, community projects, and reflection assignments, students have encountered the complexity of food systems and the challenges-opportunities they pose. 
 As educators, we have grappled with the tensions of challenging dominant positivist discourses in public health nutrition. Politicized topics such as migrant farm-worker regimes, industrial food production, regulation of food marketing, and mitigation of the impact of colonization have generated debates in the classroom about the role and scope of dietetic practice. Most students have situated themselves more explicitly within a food system, and some began to question hidden structures of power. While it remains challenging to address this breadth within the constraints of one course, we believe it worthwhile to model and stimulate critical reflexivity with the next generation of dietitians as critical food learners-teachers themselves. Even though the course is no longer offered using this food systems approach, course components can be integrated throughout the dietetic curriculum.

Three Lesson Series Improves Student Confidence in Ability to Apply Evidence-Based Practice in Dietetics

The Code of Ethics for the Nutrition and Dietetics Profession states that science-based decisions, derived from the best available evidence, are the underpinnings of ethical practice.1 Nutrition and dietetics practitioners must engage in evidence-based practice to meet professional standards and protect individual clients, the community, and the profession.1 Although the number of evidence-based nutrition guidelines continues to grow, end-user adoption of these guidelines remains a barrier to achieving consistent, evidence-based practice within the profession.

Building a shared language for socially just dietetic practice.

Building a shared language for socially just dietetic practice.

Quality improvement strategies enhance primary care dietetics: A systematic review and meta-analysis.

Quality improvement strategies have been widely applied in health care; however, little is known about their use in primary care dietetics. This review aims to describe and evaluate the effectiveness of quality improvement strategies that seek to improve patient outcomes by enhancing dietetic care compared to standard dietetic care. The study employed a systematic review and meta-analysis design following PRISMA guidelines and included studies up to March 2021. Studies were included if they used a randomised controlled trial (RCT) design to evaluate the effect of a quality improvement strategy applied to care delivered by a dietitian on patient outcomes. A meta-analysis was conducted where there were sufficient studies with homogeneous populations and outcome measures. Twelve RCTs (n = 1604) met the inclusion criteria for review and five studies (n = 511) were eligible for meta-analysis for glycated haemoglobin in patients with type 2 diabetes. The most frequently reported quality improvement strategies addressed disease management programs (58%), patient education (67%), group care (42%) and patient self-management (42%). A positive intervention effect was reported in 50% of the included studies. A low grade of evidence supported a positive intervention effect for quality improvement intervention by a dietitian for glycated haemoglobin (pooled mean difference = -0.39% with 95% confidence interval=-0.70 to -0.08, p = 0.01) in n = 511 patients with type 2 diabetes mellitus. Interventions aimed at enhancing quality in primary care dietetic practice support improvements in patient outcomes. Further research on quality improvement interventions for patient outcomes is required to strengthen the evidence base in this important topic.

Predictors of nutrition care process knowledge and use among dietitians internationally.

The nutrition care process (NCP) and its associated standardised terminology (NCPT, referred to collectively as NCP/T) forms a problem-solving framework fundamental to dietetic practice. Global implementation would assist in confirming outcomes from dietetic care, but implementation rates have varied between countries. We investigated which factors predict NCP/T knowledge and use among dietetic professionals in an international cohort, aiming to understand how implementation can be strengthened. The validated International NCP Implementation Survey was disseminated to dietitians in 10 countries via professional networks. Implementation, attitudes and knowledge of the NCP/T along with workplace and educational data were assessed. Independent predictive factors associated with higher NCP/T knowledge and use were identified using backward stepwise logistic regression. Data from 6149 respondents was used for this analysis. Enablers that were independent predictors of both high knowledge and frequent use of NCP/T were peer support, recommendation from national dietetic association and workplace requirements (all p < 0.001). Country of residence and working in clinical settings (p < 0.001) were demographic characteristics that were independent predictors of high knowledge and frequent use of NCP/T. A high knowledge score was an independent predictor of frequent NCP/T use (p = 0.002). Important modifiable enablers for NCP knowledge and use rely on organisational management. National dietetic organisations and key stakeholders such as employers are encouraged to integrate active NCP/T support in their leadership initiatives. This could take the form of policies, formalised and structured training strategies, and informatics initiatives for the integration in electronic health records.

Practices and resilience of dieticians during the COVID-19 pandemic: a national survey in the United Arab Emirates

BackgroundThe COVID-19 pandemic impacted the practices and resilience of most healthcare workers, including dieticians. In addition to offering critical care to COVID-19 patients, dieticians play a major role in preventing and managing conditions known to affect COVID-19, such as obesity and metabolic disorders. The objective of this study was to examine the conditions and changes in the work environment as well as resilience and its correlates among dieticians during the COVID-19 pandemic in the United Arab Emirates (UAE).MethodsA cross-sectional national survey was conducted among dieticians practicing in the UAE (n = 371), using a web-based questionnaire. The questionnaire addressed, in addition to the sociodemographic information, the practice-related characteristics and resilience of participants. For the latter the Connor–Davidson Resilience Scale© was used. Descriptive statistics as well as simple and multiple linear regressions were used in the statistical analysis.ResultsOf participants, 26.4% reported not having access to personal protective equipment and 50% indicated being concerned for their safety and health. Furthermore, considerable proportions of participants were not satisfied (45%) with the support nor with the appreciation (37.7%) they received during the pandemic. One in four dieticians considered quitting his/her job. While 65.8% of participants reported counseling COVID-19 patients, a third did not use any online platform for counseling. The most cited challenge to dietetic practice during the pandemic was ‘maintaining work-life balance’ (43.1%). The mean CD-RISC score was 72.0 ± 14.0. After adjustment, working in a hospital or public clinic (as opposed to private clinic), having a condition preventing face-to-face counseling, considering quitting job and feeling neutral or dissatisfied with the appreciation were associated with lower resilience scores, while counseling COVID-19 patients was associated with higher scores.ConclusionsDespite the fairly high resilience among dieticians practicing in the UAE during the COVID-19 pandemic, the findings of this study highlighted a few challenges, mainly related to safe practice environment, support for online counseling, and maintaining work-life balance. Concerted efforts of policy and decision makers ought to develop targeted programs for dieticians to ensure their retention and wellbeing during the COVID-19 pandemic.

Guidance for Professional Use of Social Media in Nutrition and Dietetics Practice

Guidance for Professional Use of Social Media in Nutrition and Dietetics Practice

Nutritional interventions in patients with head and neck cancer undergoing chemoradiotherapy: Current practice at the Dutch Head and Neck Oncology centres.

ObjectiveTo assess variations in nutritional interventions during chemoradiotherapy (CRT) among the Dutch Head and Neck Oncology centres (HNOCs).MethodsAn online questionnaire about nutritional interventions and dietetic practices was sent to 14 oncology dietitians of the HNOCs.ResultsThe response rate was 93%. The number of scheduled dietetic consultations varied from two to seven during CRT. Most centres (77%) reported using a gastrostomy for tube feeding in the majority of patients. Gastrostomies were placed prophylactically upon indication (39%) or in all patients (15%), reactive (15%), or both (31%). For calculating energy requirements, 54% of the dietitians used the Food and Agriculture Organization/World Health Organization and United Nations University (FAO/WHO/UNU) formula and 77% uses 1.2–1.5 g/kg body weight for calculating protein requirements. Almost half of the centres (46%) reported to remove the gastrostomy between 8 and 12 weeks after CR. Most centres (92%) reported to end dietary treatment within 6 months after CRT.ConclusionThis study shows substantial variation in dietetic practice, especially in the use of a gastrostomy for tube feeding, between the HNOCs. There is a need for concise dietetic guidelines.

Dietary-nutritional needs in tennis: A narrative review

Introduction: Tennis is characterized by a large number of competitions and little recovery time between them. Thus, tennis players and coaching staff have become interested in the role that nutrition can play in maximizing sports performance. The scientific literature does not have recent narrative and/or systematic reviews about to nutrition in tennis. The aim of this study is to map, describe and discuss the state of the science of nutrition and dietetic practices for tennis players from a theoretical and contextual point of view, to enable focused future systematic reviews.Material and methods: A narrative review through the Dialnet, Elsevier, Medline, Pubmed and Web of Science databases, through a search strategy based on keywords separated by Boolean connectors. A series of inclusion / exclusion criteria were applied to select those investigations that responded to the aim of the work.Results: Nutritional recommendations on carbohydrate intake depend on the training load, 5-7 g/kg/day g/kg/day for normal training and 7-10 g/kg/day for competitive periods or high training load. The recommended protein intake is 1.8 g/kg/day and 1 g/kg/day of lipids. The supplements that can optimize tennis performance are caffeine, sodium bicarbonate, creatine and β-alanine. Beetroot juice can be a possible aid to consider in dietetic-nutritional planning in tennis players.Conclusions: Performance and health of tennis player can be optimized, as well as adequate periodization of nutrients and supplements, meeting to the physiological demands of tennis.

Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: Revised 2021 standards of practice and standards of professional performance for registered dietitian nutritionists (competent, proficient, and expert) in nutrition support

Nutrition support is a therapy that crosses all ages, diseases, and conditions as health care practitioners strive to meet the nutrition requirements of individuals who are unable to meet nutrition and/or hydration needs with oral intake alone. Registered dietitian nutritionists (RDNs), as integral members of the nutrition support team provide needed information, such as identification of malnutrition risk, macro- and micronutrient requirements, and type of nutrition support therapy (eg, enteral or parenteral), including the route (eg, nasogastric vs nasojejunal or tunneled catheter vs port). The Dietitians in Nutrition Support Dietetic Practice Group, American Society for Parenteral and Enteral Nutrition, along with the Academy of Nutrition and Dietetics Quality Management Committee, have updated the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for RDNs working in nutrition support. The SOP and SOPP for RDNs in Nutrition Support provide indicators that describe the following 3 levels of practice: competent, proficient, and expert. The SOP uses the Nutrition Care Process and clinical workflow elements for delivering patient/client care. The SOPP describes the 6 domains that focus on professional performance. Specific indicators outlined in the SOP and SOPP depict how these standards apply to practice. The SOP and SOPP are complementary resources for RDNs and are intended to be used as a self-evaluation tool for assuring competent practice in nutrition support and for determining potential education and training needs for advancement to a higher practice level in a variety of settings.

The Future of Dietetics Practice Is Global: A Call for a Unified Approach to Measuring Diet Quality

The Future of Dietetics Practice Is Global: A Call for a Unified Approach to Measuring Diet Quality

Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: Revised 2021 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Nutrition Support

Nutrition support is a therapy that crosses all ages, diseases, and conditions as health care practitioners strive to meet the nutritional requirements of individuals who are unable to meet nutritional and/or hydration needs with oral intake alone. Registered dietitian nutritionists (RDNs), as integral members of the nutrition support team provide needed information, such as identification of malnutrition risk, macro- and micronutrient requirements, and type of nutrition support therapy (eg, enteral or parenteral), including the route (eg, nasogastric vs nasojejunal or tunneled catheter vs port). The Dietitians in Nutrition Support Dietetic Practice Group, American Society for Parenteral and Enteral Nutrition, along with the Academy of Nutrition and Dietetics Quality Management Committee, have updated the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for RDNs working in nutrition support. The SOP and SOPP for RDNs in Nutrition Support provide indicators that describe the following 3 levels of practice: competent, proficient, and expert. The SOP uses the Nutrition Care Process and clinical workflow elements for delivering patient/client care. The SOPP describes the 6 domains that focus on professional performance. Specific indicators outlined in the SOP and SOPP depict how these standards apply to practice. The SOP and SOPP are complementary resources for RDNs and are intended to be used as a self-evaluation tool for assuring competent practice in nutrition support and for determining potential education and training needs for advancement to a higher practice level in a variety of settings.

CFDR Research Showcase: Early Bird Abstracts

Given the pandemic challenges we experienced over the last year, the 2021 Dietitians of Canada (DC) National Conference from May–June brought our dietetic community together from all across Canada and the world. This year the Canadian Foundation for Dietetic Research (CFDR) showcased another successful event with novel, relevant, timely research projects via the OnAIR Virtual Event Portal. Twenty-four research abstracts were submitted and reviewed by the Early Bird Abstract Review Committee. It was exciting to have research from different nutrition and dietetic practice areas represented. Thanks for all of the abstract submissions! Eight Early Bird abstracts were presented as Lightning Rounds during the virtual DC National Conference and were very well-received. The remaining 16 abstracts were displayed as posters for the duration of the conference with a live 7-min presentation opportunity from the poster gallery on May 19, 2021. All of the Early Bird abstracts are published in this issue of the Canadian Journal of Dietetic Practice and Research and are also featured on the CFDR website. These abstracts represent a wide variety of practice-based nutrition research projects in Canada. The Early Bird abstract research event would not have been possible without the commitment and dedication of many supportive individuals. On behalf of DC and CFDR, we extend a special thank you to members of our abstract review committee: Susan Campisi (University of Toronto); Pauline Darling (University of Ottawa); Andrea Glenn (St. Francis Xavier University); Mahsa Jessri (University of British Columbia); Grace Lee (University Health Network), Jessica Lieffers (University of Saskatchewan); Shelley Vanderhout (University of Toronto). A sincere thank you to all of the moderators, the DC Conference team and Izabella Bachmanek for their support with the Lightning Round presentations over the course of the DC virtual conference. Please consider submitting an abstract next year for the CFDR Research Showcase at the 2022 DC National Conference in Saskatoon, SK. Wishing all of you a wonderful Fall! Warm regards, Christina Lengyel PhD RD Chair, 2021 Early Bird Committee Professor Director of the Dietetics Program Food and Human Nutritional Sciences University of Manitoba Janis Randall Simpson PhD RD FDC FCNS Executive Director, CFDR Professor Emerita University of Guelph This article was corrected after publication.

Exploring dietitians' practice and views of giving advice on dietary patterns to patients with type 2 diabetes mellitus: A qualitative study.

Dietary guidelines for type 2 diabetes mellitus (T2DM) emphasise weight management and individualised total carbohydrate intake. Evidence on the most effective dietary patterns (DPs) for T2DM management is mixed, potentially leading to variations in the advice that dietitians provide. The present study aimed to explore dietitians' practice of DP advice provision to adults with T2DM, as well as understand their views when advising their patients on the DPs deemed effective for glycaemic management or recommended by current guidelines. Semi-structured interviews were conducted with 12 UK-registered dietitians, with experience in consulting adults with T2DM. Dietitians were asked for their views on five DPs recommended for glycaemic management of T2DM. Interview transcripts were analysed using deductive and inductive thematic analysis. Nine themes were identified that draw attention to DP advice provision practices, the five DPs (low-carbohydrate, low-fat, low-glycaemic index, Mediterranean diet and Dietary Approaches to Stop Hypertension diet), other DPs, the barriers and facilitators to DP advice provision and following this advice, and the factors affecting the provision of DP advice. Participants' current practice of DP advice provision to patients with T2DM was perceived to be individualised and patient-centred. Participants discussed their current practice and perceptions of available evidence and how patients respond to advice on the DPs shown to be effective for glycaemic management. Several barriers to providing advice on specific DPs, including safety and compliance challenges, were identified. Participants also highlighted factors that would facilitate the provision of advice on specific DPs and would help patients to follow this advice, including social support, educational resources and more robust scientific evidence. The findings of the present study provide important insights regarding dietitians' views of promoting whole DPs to patients with T2DM. Emerged barriers and facilitators should be considered when developing future guidance for dietetic practice to support patients with following whole DPs for T2DM management.

Variation in Neonatal Nutrition Practice and Implications: A Survey of Australia and New Zealand Neonatal Units.

Background: Significant global variation exists in neonatal nutrition practice, including in assigned milk composition values, donor milk usage, fortification regimens, probiotic choice and in methods used to calculate and report nutrition and growth outcomes, making it difficult to synthesize data to inform evidence-based, standardized nutritional care that has potential to improve neonatal outcomes. The Australasian Neonatal Dietitians' Network (ANDiN) conducted a survey to determine the degree to which neonatal nutritional care varies across Australia and New Zealand (A&NZ) and to highlight potential implications.Materials and Methods: A two-part electronic neonatal nutritional survey was emailed to each ANDiN member (n = 50). Part-One was designed to examine individual dietetic practice; Part-Two examined site-specific nutrition policies and practices. Descriptive statistics were used to examine the distribution of responses.Results: Survey response rate: 88%. Across 24 NICU sites, maximum fluid targets varied (150–180 mL.kg.d−1); macronutrient composition estimates for mothers' own(MOM) and donor (DM) milk varied (Energy (kcal.dL−1) MOM: 65–72; DM 69–72: Protein (g.dL−1): MOM: 1.0–1.5; DM: 0.8–1.3); pasteurized DM or unpasteurized peer-to-peer DM was not available in all units; milk fortification commenced at different rates and volumes; a range of energy values (kcal.g−1) for protein (3.8–4.0), fat (9.0–10.0), and carbohydrate (3.8–4.0) were used to calculate parenteral and enteral intakes; probiotic choice differed; and at least seven different preterm growth charts were employed to monitor growth.Discussion: Our survey identifies variation in preterm nutrition practice across A&NZ of sufficient magnitude to impact nutrition interventions and neonatal outcomes. This presents an opportunity to use the unique skillset of neonatal dietitians to standardize practice, reduce uncertainty of neonatal care and improve the quality of neonatal research.

Compassionate Bodies, Compassionate Practice: Navigating Body Image Tensions among Gay Men.

Our purpose in writing this Perspective in Practice is to create awareness about the role of compassion within dietetic practice, particularly the role of compassion for body image tensions. Nine self-identifying gay men were recruited to a photovoice research study that explored their beliefs, values, and practices relating to food and their bodies. Compassion was found as one way to navigate body images tensions. It is not the intent of this article to review all aspects of this research study but to use it as an example to illustrate compassion in dietetics. We suggest that our findings reveal the strength of using compassionate practice within the dietetic profession. In doing so, we call upon dietitians to incorporate compassion into their clinical and client care practices to foster health and healing for all communities, especially among those who struggle with body image tensions.

Clinical Leadership in Dietetics

Clinical leadership has been addressed in many health care professions; yet, there is little research in dietetics. This qualitative study explored registered dietitian nutritionists' (RDNs'; n = 561) perspectives on what clinical leadership is in dietetics practice and what barriers exist to practicing it. Two thematic analyses were explored. RDNs described dietetics clinical leadership as including strong technical skills, interpersonal interactions, and specific personal attributes. RDNs described barriers to practicing clinical leadership that included the work environment, limited resources, and individual circumstances/attributes. Managers may consider these perspectives as they work with clinical RDNs, and educators can incorporate these findings into the dietetics curriculum.

P50 Exploring the Experiences of Registered Dietitian Nutritionists (RDNs) who Educate Through Cooking and Food Preparation

<h3>Background</h3> Registered Dietitian Nutritionists (RDNs) often provide guidance on preparing healthy meals. Although food science and culinary skills are addressed in coursework to become a RDN, those involved in nutrition education do not universally incorporate hands-on cooking in their practice. Cooking skills, knowledge and confidence have declined among the public, while rates of obesity and chronic disease are on the rise. RDNs can play a central role in teaching essential cooking skills and food-related knowledge. This calls for exploration on the perspectives and characteristics of RDNs drawn to culinary education. Few studies have investigated the personal experiences and viewpoints of RDNs involved in teaching the public how to cook. <h3>Objective</h3> To explore the perspectives of RDNs who teach cooking and food preparation, to better understand their experiences learning to cook and teaching others. Cooking-related knowledge/skills perceived as lacking among the public and necessary to perform their role are compared with competencies outlined by the Academy of Nutrition and Dietetics' Food and Culinary Professionals (FCP) Dietetic Practice Group. <h3>Study Design, Setting and Participants</h3> The research design is cross-sectional and qualitative. Face-to-face semi-structured interviews are conducted remotely via Microsoft Teams. A convenience sample is recruited from community settings, including private practice, worksite wellness, supermarkets, Expanded Food and Nutrition Education Program, and SNAP-Ed. <h3>Analysis</h3> Interviews are recorded, transcripts are coded, and recurring themes are summarized. <h3>Results</h3> Analysis of pilot data (n = 14) on experiences learning to cook indicate cooking at home with parents while growing up, food science coursework, and personal interest in cooking. Emerging themes mirrored several FCP competencies, including communication skills, knife skills, ingredient substitution, time management, meal planning and food safety. <h3>Conclusion</h3> This pilot study examines the perspectives of RDNs who teach hands-on cooking, thereby providing insights on the competencies needed to teach others and best serve the public. Our findings merit research with a larger sample to further compare with FCP competencies, and potentially inform dietetics education programs preparing students for careers as RDNs.