Nutrition Care Process Research Articles

Nutritional diagnoses in people with type 2 diabetes: association with metabolic, anthropometric, and dietary parameters

BackgroundNutritional diagnosis involves identifying a nutritional problem, its cause, and the signs that indicate it to guide appropriate treatment. Few studies report on the most prevalent nutritional diagnoses in people living with type 2 diabetes (T2D).ObjectiveTo define nutritional diagnoses across different domains and their association with metabolic, anthropometric, and dietary parameters in individuals with T2D.MethodsA personalized nutritional intervention was conducted using the Nutrition Care Process (NCP) model, which encompasses assessment, diagnosis, intervention, and evaluation, utilizing standardized terminology from the Nutrition Care Process Terminology (NCPT). Two dietitians, trained and standardized in applying the NCP and NCPT, performed patient assessments and established the diagnoses. Patients over 18 years old with a diagnosis of T2D for less than 5 years were included.ResultsData from 2,050 patients were analyzed, of whom 55.3% were women, and 44.7% were men, with a median age of 57 and 54 years, respectively. The most prevalent nutritional diagnosis was excessive energy and carbohydrate intake. Diagnoses were distributed across domains: Intake (55.9%), Behavioral/Environmental (32.7%), Clinical (10.2%), and 1.2% without nutritional diagnosis. Significant intergroup differences were observed in anthropometric variables such as BMI, waist circumference, and body fat percentage (p < 0.05). HbA1c and glucose levels were significantly higher in the Intake and Behavioral groups (p < 0.001). Albumin/creatinine ratio (ACR) was higher in the ingestion group (p = 0.007). Caloric and carbohydrate intake were higher in the ingestion group, while protein and fat intake were higher in the clinical and behavioral groups (p < 0.001).ConclusionNutritional diagnoses in the intake domain, followed by behavioral/ environmental and clinical domains, are highly prevalent in people with T2D and are associated with worse metabolic control, higher BMI, and increased energy and carbohydrate intake. Timely identification of issues in these domains can support targeted nutritional therapy to improve disease management and promote a healthy lifestyle.Clinical trial registrationhttps://clinicaltrials.gov/study/NCT02836808?term=caipadi&rank=2, Identifier (NCT02836808).

Using Technology to Improve the Nutrition Care Process at a Medically Tailored, Home-delivered Meal Program

Using Technology to Improve the Nutrition Care Process at a Medically Tailored, Home-delivered Meal Program

Student Exposure to ANDHII Part II: Improved Confidence with Applying the Nutrition Care Process Across Cohorts

Student Exposure to ANDHII Part II: Improved Confidence with Applying the Nutrition Care Process Across Cohorts

Exploration of Barriers and Enablers for the Use of the Nutrition Care Process Among a Diverse Sample of Registered Dietitians/ Nutritionists

Exploration of Barriers and Enablers for the Use of the Nutrition Care Process Among a Diverse Sample of Registered Dietitians/ Nutritionists

Development and validation of the attitude scale for the clinical nutrition care process of hospitalized patients for physicians

Objective: Evaluating physicians’ attitudes towards malnutrition and clinical nutrition in hospitalized patients are crucial for the implementation of optimal nutritional care process and the prevent of hospital malnutrition. The aim of this study is to develop a scale that evaluates physicians’ attitudes towards malnutrition in hospitalized patients. Methods: Based on the existing literature on clinical nutrition and the clinical experience of experts in this field, a 5-point Likert-type attitude scale consisting of 12 items was developed. Analysis was carried out using Parallel Analysis to determine the number of factors in the Exploratory factor analysis based on the Polychoric correlation matrix and Unweighted Least Squares as the factor extraction method. Results: There are 8 items in the 1st factor (Physician duties) and 4 items in the 2nd factor (Non-Physician duties). The Cronbach Alpha and McDonald’s Omega coefficients of the scale were found to be 0.72 and 0.81 respectively, from the sub-dimensions 0.78 and 0.85 for the 1st Factor, and 0.66 and 0.75 for the 2nd Factor. Conclusion: Attitude scale for the clinical nutrition care process of hospitalized patients for physicians is an instrument with good psychometric properties that measures examination of physicians’ attitudes related to clinical nutrition care process.

Lost in Transition: Insights from a Retrospective Chart Audit on Nutrition Care Practices for Older Australians with Malnutrition Transitioning from Hospital to Home.

Care transitions from hospital to home for older adults with malnutrition present a period of elevated risk; however, minimal data exist describing the existing practice. This study aimed to describe the transition of nutrition care processes provided to older adults in a public tertiary hospital in Australia. A retrospective chart audit conducted between July and October 2022 included older (≥65 years), malnourished adults discharged to independent living. Dietetic care practices (from inpatient to six-months post-discharge) were reported descriptively. Of 3466 consecutive admissions, 345 (10%) had a diagnosis of malnutrition documented by the dietitian and were included in the analysis. The median number of dietetic visits per admission was 2.0 (IQR 1.0-4.0). Nutrition-focused discharge plans were inconsistently developed and documented. Only 10% of patients had nutrition care recommendations documented in the electronic discharge summary. Post-discharge oral nutrition supplementation was offered to 46% and accepted by 34% of the patients, while only 23% attended a follow-up appointment with dietetics within six months of hospital discharge. Most patients who are seen by dietitians and diagnosed with malnutrition appear lost in transition from hospital to home. Ongoing work is required to explore determinants of post-discharge nutrition care in this vulnerable population.

Implementation of nutrition care process in Indonesian athletes and its effect on nutritional status and aerobic capacity performance

Introduction: Despite the critical function of a nutritionist, only a few sports training centres for students in Indonesia have one. This study aimed to determine the effect of the nutrition care process (NCP) on athletes’ nutritional status and aerobic capacity performance. Methods: This cohort study was conducted in 2022 (May–August) in four training centres (TC) in Indonesia. Subjects were athletes who have been dwelling in TC for at least three months, excluding those absent for >14 days due to a competition or other commitments during the data collection period. NCP included the assistance of trained sports nutritionists. In total, 114 athletes participated in this study: 90 strength athletes and 24 endurance athletes. The participants were aged 14-19 years old with approximately (mean+SD) 6+2.5 years of experience in specific sports. Results: After three months of NCP, knowledge of nutrition (p=0.013), body fat composition (p<0.001), skinfold thickness scores (p<0.001), and performance (p<0.001) of athletes significantly improved. In spite of good intakes of protein and fat, none of the intakes showed significant changes (p>0.05). Furthermore, improved knowledge of sports nutrition and exercise science had a positive impact on dormitory meal choices. Conclusion: Overall, three months of NCP had a significant effect on athletes’ knowledge of nutrition, body fat composition, skinfold thickness, and also VO2Max.

Artificial intelligence chatbots for the nutrition management of diabetes and the metabolic syndrome.

Recently, there has been a growing interest in exploring AI-driven chatbots, such as ChatGPT, as a resource for disease management and education. The study aims to evaluate ChatGPT's accuracy and quality/clarity in providing nutritional management for Type 2 Diabetes (T2DM), the Metabolic syndrome (MetS) and its components, in accordance with the Academy of Nutrition and Dietetics' guidelines. Three nutrition management-related domains were considered: (1) Dietary management, (2) Nutrition care process (NCP) and (3) Menu planning (1500 kcal). A total of 63 prompts were used. Two experienced dietitians evaluated the chatbot output's concordance with the guidelines. Both dietitians provided similar assessments for most conditions examined in the study. Gaps in the ChatGPT-derived outputs were identified and included weight loss recommendations, energy deficit, anthropometric assessment, specific nutrients of concern and the adoption of specific dietary interventions. Gaps in physical activity recommendations were also observed, highlighting ChatGPT's limitations in providing holistic lifestyle interventions. Within the NCP, the generated output provided incomplete examples of diagnostic documentation statements and had significant gaps in the monitoring and evaluation step. In the 1500 kcal one-day menus, the amounts of carbohydrates, fat, vitamin D and calcium were discordant with dietary recommendations. Regarding clarity, dietitians rated the output as either good or excellent. Although ChatGPT is an increasingly available resource for practitioners, users are encouraged to consider the gaps identified in this study in the dietary management of T2DM and the MetS.

Prevalence of Malnutrition and Influence of an Individualized Nutritional Support on the Nutritional Status of Cancer Patients

Background: Muscle mass loss, impaired dietary intake, and poor nutritional status are hallmarks of patients with cancer. Cancer-associated malnutrition can lead to several negative consequences, including poor prognosis, reduced survival, increased therapy toxicity, reduced tolerance and compliance to treatment, and diminished response to drugs. The main aim of this study is to understand the prevalence of malnutrition using Global Leadership Initiative on Malnutrition Criteria (GLIM Criteria) and evaluate the impact of tailor-made nutritional intervention on the nutritional status of patients with cancer. Methods and Material: An interventional prospective study was conducted among 100 adult hospitalized cancer patients. The study was based on the Nutrition Care Process model, where nutritional assessment was done using GLIM criteria and Malnutrition Universal Screening Tool (MUST), and muscle mass was assessed using the Handgrip Dynamometer. Nutritional diagnosis was made based on assessment; nutritional intervention was provided through Individualized Nutritional Counseling & Oral Nutritional Support, and nutritional monitoring was done for patients during their stay in hospital using 24-hour daily dietary recall. Nutritional evaluation was done at the time of discharge using GLIM criteria, MUST, and Handgrip Strength (HGS). Data analysis was done using SPSS v24 statistical software (developed by IBM) to find out the Mean and Standard Deviation. Paired t test, Chi-square test, and Regression Analysis were used to analyze the qualitative variables. Statistical significance was defined as P < 0.05. Results: The current study evaluated 100 participants among whom 26% of participants were malnourished as assessed by MUST and 22% participants had poor muscle strength. A paired t-test was performed and it was found that the calorie intake (1504.1 ± 158.7) and the protein intake (56.08±7.01) were almost double after the nutrition intervention. The difference was found to be highly statistically significant with P < 0.01. Thus, nutrition intervention significantly (P < 0.01) improved calorie and protein intake. The overall mean MUST score at baseline was 0.39 which was reduced significantly (P < 0.000) to 0.17 at the end of the study. The HGS improved significantly (P < 0.000) from 10.02 to 25.51 after the nutrition intervention and it was evidenced by 2.5 times increase in HGS (25.51 ± 2.40) by the end of the study. Conclusion: Individualized nutritional support with continuous monitoring and counseling resulted in improvement in nutritional status as evidenced through their improved MUST score and HGS.

Impact of a Registered Dietitian Nutritionist–Led Food as Medicine Program in the Food Retail Setting: A Feasibility Study

BackgroundFood as medicine (FAM) interventions have been associated with improved health outcomes. However, there is limited FAM evidence in food retail settings. ObjectiveThe objective was to evaluate the feasibility of a registered dietitian nutritionist–led FAM program that aims to detect changes in participants’ nutrition problems and related nutrition and health outcomes, as documented by the Nutrition Care Process framework. DesignThe study was a descriptive feasibility nutrition intervention cohort analysis. Participants settingA convenience sample of online food shoppers were enrolled in collaboration with a food retail chain (n = 39 participants completed the intervention and were included in primary analyses). InterventionParticipants received nutrition care for 6 months either in person or via telehealth. The FAM intervention included tailored nutrition care that integrated software-generated meal plans and food shopping lists to support online food shopping. Main outcome measuresProgress of nutrition problems and diet quality (assessed via the Picture your Plate survey) were measured. Measurements included changes in anthropometric and biochemical parameters, blood pressure, and quality of life (assessed via the Centers for Disease Control and Prevention’s Health Related Quality of Life-14 survey). Statistical analyses performedMann-Whitney U test, Pearson’s χ2, and Wilcoxon signed-rank tests were used to detect differences. ResultsThe most prevalent nutrition problems demonstrated improvement rates as follows: excessive energy intake, 81% (n = 21 of 26); excessive carbohydrate intake, 88% (n = 7 of 8); and obesity, 100% (n = 5 of 5). Exposure to the FAM intervention improved dietary quality, quality of life, body weight, waist circumference, and systolic pressure. ConclusionsFAM interventions can be carried out by in-store registered dietitian nutritionists in the supermarket setting. This feasibility study highlighted the need and opportunity for larger studies in which registered dietitian nutritionist–led FAM interventions, in collaboration with food retailers, may improve people’s nutrition and health.

Nutrition Care Process on Obesity Patient with Acute Decompensated Heart Failure (ADHF) Wet and Warm, Atrial Fibrillation Moderate Ventricular Response, and Acute Kidney Injury: A Case Report

Background: Obesity is caused by an imbalance between excessive energy intake and insufficient physical activity over a prolonged period. Obesity can increase the risk of metabolic syndrome, including heart failure. Severe heart failure can further elevate the risk of complications such as atrial fibrillation and acute kidney injury. In order to mitigate the exacerbation of heart failure severity in obese patients, it is imperative to institute a cardiovascular diet therapy employing the principles of adequate energy provision, low-fat content, and restricted protein intake within the framework of a Nutrition Care Process (NCP). Objective: To investigate the management of standard nutritional care in obese patients with acute decompensated heart failure, atrial fibrillation, and acute kidney injury through the administration of a cardiovascular diet. Methods: A case study was conducted in February 2023 on a patient at the University of Airlangga Infectious Disease Hospital, Surabaya. Results: The results of the clinical evaluation demonstrated an improvement in the patient's physical condition, as evidenced by the absence of dyspnea and stable vital signs within the normal range at the end of the intervention. The patient's food intake increased progressively, although some macronutrient targets were not fully met (<75%). Conclusion: The patient's condition showed significant improvement, as indicated by positive changes in physical/clinical monitoring. Additionally, there was an increase in food intake, although the target macronutrient intake was not fully achieved.

The Global Malnutrition Composite Score: Impacting malnutrition care.

The presence and impact of malnutrition in adult hospitalized patients has been well documented by a significant body of literature. However, current malnutrition care practices often vary widely and frequently lack standardization. The Global Malnutrition Composite Score (GMCS), the first nutrition-related electronic clinical quality measure, is intended to evaluate the quality of malnutrition care provided to inpatient adults. This measure aims to aid in standardizing malnutrition care through performance measurement. The four components of the measure (nutrition screening, nutrition assessment, malnutrition diagnosis, and nutrition care plans) follow the well-established Nutrition Care Process and encourage the use of standardized terminology. Facilities with high-performance scores on the GMCS are likely to experience improved outcomes associated with high-quality malnutrition care.

Assessing the Level of Knowledge, Implementation Practices, and Use of Digital Applications for the Optimal Adoption of the Nutrition Care Process in Greece.

The level of NCP implementation varies across countries due to differences identified in major components of health systems such as infrastructures, legislation, training, and cultural diversities. Dietitians in Greece receive sufficient training in the implementation of the NCP as part of their main studies; however, the level of awareness and adoption of the NCP model is still quite low, with limited information on the potential barriers. The primary aim of this study was to gain a deeper understanding of the perspectives of Greek dietitians on the NCP and the use of digital tools. An online survey was created and distributed through the platform "SurveyMonkey version 4.1.1". The overall structure of the questionnaire was modeled according to the validated NCP/NCPT INIS Tool. A total of 279 subjects were included in this study, and 192 were aware of the NCP tool. The most important challenges for the implementation of the NCP included communication with other healthcare professionals (68.2%), provision of appropriate care (33.9%), and insufficient access to continuous education (29.2%). Of the 192 participants who knew the NCP, 81.3% reported using digital applications for the collection and assessment of health data, while 18.8% indicated that they did not utilize such tools. No relationship was found between the use of digital applications by dietitians, NCP knowledge, and demographic characteristics. Our findings highlight the need for targeted educational interventions and appropriate application of standardized protocols by Greek dietitians in daily practice. National Dietetic Associations should provide sufficient guidance on digital tool utilization in facilitating patient data management and enhancing NCP implementation.

Update nutritional management in patients with pancreatic ductal adenocarcinoma: A literature reviews

Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignancies. Only 20 % of patients are operable at the time of diagnosis. However, the survival rate varies among patients depending on immune response and nutritional status. Weight loss (WL) is frequent and multifactorial, so anorexia-cachexia syndrome and exocrine pancreatic insufficiency (EPI) should be considered. The nutritional care process must be carried out in all cases from the moment of suspected diagnosis and during the disease. The management of patients with PDAC must be personalized, individualizing behaviors, and from a multidisciplinary perspective at each stage of the disease. The objective of the present review is to offer a tool that facilitates the identification of individuals at nutritional risk and to describe the most appropriate nutritional strategies to improve the quality of care for patients with PDAC.

Nutrition care for older adults with delirium: A scoping review.

This scoping review aimed to identify and map the available information on the nutrition care process in older adults with delirium to analyse and summarise key concepts, and gaps, including the barriers and enablers to providing nutrition care for this group. Scoping review. This review was conducted in accordance with the JBI methodology for scoping reviews. Published and grey sources in English were considered. Databases searched were CINAHL, Medline, Embase, JBI Evidence-based Practice, Scopus, ProQuest and Google. The initial search was conducted from October 2021 to March 2022 and repeated in October 2023. The database search identified 1561 articles, 186 underwent full-text review and 17 articles were included. The grey literature search identified eight articles. Malnutrition and delirium were identified as mutually reinforcing, and nutrition strategies were included as part of multicomponent interventions for delirium management. There was no mention of barriers or enablers to nutrition care and minimal descriptive or empirical data available to guide nutrition care processes in this group. This scoping review revealed a need for further research into nutrition care processes in older patients with delirium, in particular the barriers and enablers, to inform appropriate management strategies in this vulnerable group. Providing nutrition care for older patients with delirium is important and further practical guidance could help patients, healthcare staff and families. This scoping review yielded instructive data suggesting that delirium is an important risk factor for malnutrition and vice versa, which leads to poor patient and health service outcomes. This scoping review adhered to relevant EQUATOR guidelines and used the Preferred Reporting Items For Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). No patient or public contribution.

Global Leadership Initiative on Malnutrition (GLIM) for the diagnosis of malnutrition - a framework for consistent dietetic practice

Malnutrition is an alarming and ongoing healthcare problem globally. Malnutrition has a negative impact on the individual patient, leading to poorer clinical outcomes and increased mortality, but also poses an economic burden on society. Proper identification and diagnostics are prerequisites for initiation of treatment. In 2019, the Global Leadership Initiative on Malnutrition, a consensus-based global framework to uniformly diagnose malnutrition across populations, healthcare settings, and countries was published.Identifying and treating malnutrition is an interdisciplinary team effort. Nonetheless, the nutrition and dietetic profession is specifically trained for diagnosing and treating nutrition(-related) conditions, and therefore has a key role in the interdisciplinary team in implementing the GLIM framework in clinical practice. For the dietetic profession, GLIM offers a great opportunity for moving both the scientific and clinical knowledge of malnutrition management forward.While the GLIM framework has been extensively studied since its launch, various knowledge gaps still remain. For the dietetic profession, these knowledge gaps mainly relate to the GLIM implementation process, to the role of GLIM in relation to the Nutrition Care Process, and to treatment strategies for various nutrition-related conditions. In this opinion paper, we aimed to describe the rationale for implementing the GLIM framework in clinical dietetic practice, and propose a research agenda based on knowledge gaps regarding GLIM in relation to nutrition care from a dietetic point of view.

Phase Angle and Bioelectrical Impedance Vector Analysis (BIVA) in Amyotrophic Lateral Sclerosis (ALS) Patients

Phase angle (PhA) and bioelectrical impedance vector analysis (BIVA) have emerged as valuable tools for assessing nutritional status and prognosis in various patient populations, but there is a lack of studies in rare neurodegenerative diseases. The purpose of this cross-sectional study was to investigate these bioelectrical parameters in patients with amyotrophic lateral sclerosis (ALS), compared with healthy peers. The tetrapolar impedance method was applied and bioimpedance analysis (BIA) was performed. Bioelectrical parameters were obtained (Resistance—R; Reactance—Xc) or calculated (PhA; BIVA). For BIVA, bivariate vectors and confidence ellipses were graphically represented. In addition, R and Xc were used to determine body composition (BC) (Fat Mass—FM; Fat-Free Mass—FFM; and Total Body Water—TBW). In this study, 40 participants were divided into two groups: case group (n = 20, ALS patients) and control group (n = 20, healthy subjects. Our main results showed that ALS patients presented low levels of BMI, FFM, R, and Xc adjusted by height (R/H, Xc/H), hydration, and cellularity, compared to the healthy subjects. Our findings highlight BC and bioelectrical parameters, including PhA and BIVA, as valuable indicators of nutrition status, which should be implemented in the nutrition care process of ALS patients during the disease course.

Hospimeal: Website Based Nutrition Care Process Digitalization

The nutrition Care Process (NCP) is a systematic approach or standard to provide comprehensive nutritional care for patients or clients. NCP consists of 4 interrelated steps, namely nutrition assessment, nutrition diagnosis, nutrition intervention, nutrition monitoring and nutrition evaluation. Implementation of NCP in many health services facilities face some barriers because of using manual NCP, such as human error, time-consuming, and incomplete documentation. Digitalization of NCP has proven to be beneficial in terms of efficiency of time and provision of electronic data to improve patient services. This study aimed to develop Hospimeal as a website-based Nutrition Care Process (NCP). The development of the web-based NCP application carried out in this study used the waterfall method. The stages of the waterfall method are need analysis, study of literature and data retrieval, system requirements, system planning, system implementation and testing, digitalization of NCP management in website. Digitalization of Standardized Nutrition Care Process (NCP) management can be developed in the form of a website called Hospimeal. This website provides nutritional care to patients/clients starting from nutrition assessment, nutrition diagnosis, nutrition intervention, nutrition monitoring, and nutrition evaluation. The Hospimeal website can be operated by the relevant nutritionist/dietitian. At the beginning of the display there is a Login menu which can be used by nutrition-ists/dietitians to enter the website

Evaluation of the nutrition care process documentation in the patients' records using the Diet-NCP-Audit: experience in a medium-sized multi-site Swiss hospital.

The nutrition care process (NCP) is a four-step systematic approach to guide dietitians in providing high-quality nutrition care. It fosters critical thinking and enhances the consistency of dietitians' documentation. Following international recommendations, University Training Hospital of Fribourg (HFR) implemented it in 2013. This study aimed to evaluate the quality of NCP documentation in electronic patient records (EPRs) and to determine the nutrition problems dietitians most often identified while documenting their actions. The audit was performed on 92 EPRs using the Diet-NCP-Audit, which was translated into French for this study. The documentation quality was assessed as high in 62% of the EPRs, and nutrition diagnoses were mostly documented. In half of the EPRs, nutrition assessment (step 1 of the NCP) was inconsistent with nutrition diagnosis (step 2). Dietitians often used the same nutrition problems: out of the 73 nutrition problems defined in NCP terminology, only 4 (5%) represented 58% of the 189 problems identified in the EPR audit. EPRs were mostly assessed as high quality. However, the entire process requires improved consistency. The poorly documented link between the NCP steps and the restricted choices of nutrition problems dietitians identified should be addressed because they could reveal that dietitians have not fully adopted critical thinking, which the NCP stresses.

Use of an Escape Room to Enhance Nutrition Care Process Skills and Self-efficacy

Application of the Nutrition Care Process (NCP) is a fundamental concept for students preparing to become registered dietitian nutritionists (RDNs). Adequate practice, within pedagogical methods designed to mimic actual dietetics practice scenarios as realistically as possible, is necessary to increase student NCP skill proficiency and confidence. This study assessed the impact of a virtual escape room experience compared with a traditional case study on both NCP skills and confidence in a senior didactic program in dietetics for undergraduate students. Results indicate that the escape room experience improved both NCP documentation (P < .001) and student self-efficacy (P < .001).